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Prolapse and incontinence 

If you experience urgency feelings from the bladder, and/or bladder-emptying difficulties, or have noticed the presence of protruding tissue in the vagina (that many women describe as feeling like a ball), you may be dealing with pelvic organ prolapse. If so, you’re not alone.
Prolapse with or without noticeable symptoms is more common than you might think. In this article, we will focus on the kinds of prolapse that might cause urinary leakage problems. Here are a few things you should know. 

What is a pelvic organ prolapse?

The pelvis sits below the navel and between the hips. It holds multiple organs such as the bladder, cervix, intestines, rectum, urethra, uterus and vagina. Prolapse can happen for any organ within the pelvis, and occurs when the pelvic muscles weaken to such a state that they can no longer support the organ, and it descends into the vagina. This produces the symptom of protruding tissue in your genital area.
Prolapse becomes more likely as we get older. A well-known cause of prolapse is giving birth, and the more deliveries a person goes through, the greater the risk. Over-straining as a result of repeated heavy lifting can also increase your risk of prolapse, as can long-terms conditions that involve coughing or constipation. 


The symptoms of a prolapse differ depending on the type and severity of the prolapse, and may appear either gradually or suddenly. Tissue protruding from the vagina, that may feel tender or bleed, is the most specific symptom of any prolapse. Below are examples of different types of prolapse, and the symptoms they can cause on the bladder and bowel.
A prolapse condition involving the bowel, in which the wall of tissue that separates the rectum from the vagina weakens, and a distention forms in the rectum that bulges against the vaginal canal. Typical symptoms include:
  • Constipation
  • Feeling that you can’t completely empty your bowel
  • A sensation of pressure within the pelvis
  • A bulging mass felt inside the vagina
In many cases “digital evacuation” — manual pushing on the perineum (the area between the vagina and rectum) or on the posterior wall of the vagina — may help to aid in bowel movement.
A cystocele prolapse occurs when the bladder falls down and pushes in toward the vaginal space. Typical symptoms include:
  • Difficulties completely emptying the bladder when urinating
  • A frequent need to urinate
  • A bulging mass felt inside the vagina
As the prolapsed bladder compresses the urethra, it may cause bladder-emptying difficulties and feelings of urgency from the bladder. Because the bladder cannot empty completely, urinary tract infections may also result. Often, symptoms are not as severe in the morning, after the body has been horizontal during the night. But with renewed strain placed on the pelvic floor by daily activities, the symptoms return.
Symptoms may also differ from case to case. Always consult a medical professional if you experience feelings of urgency from the bladder, unclear bleedings, or something bulging out from the vagina. If you have severe bladder-emptying difficulties and feel you need to urinate but are not able to, you may require more acute help.   

Pelvic organ prolapse treatment

First and foremost, a physical exam by a physician, involving the relevant tests and a clear view of symptoms, is required to properly diagnose the type of pelvic organ prolapse. After the diagnosis, your physician will be able to decide the appropriate treatment.
A mild bladder prolapse that doesn’t produce pain or discomfort may not require any particular medical treatment, apart from avoiding heavy lifting or over-straining, and ensuring plenty of fiber and liquid intake to avoid constipation. Your physician may also recommend prolapse exercises (pelvic floor or Kegel exercises), which help strengthen the pelvic floor muscles, and are recommended as a pre-emptive measure for all women regardless of whether they are suffering from prolapse-related symptoms.
For more serious cases professional treatment may be required, which can be done with both surgical and non-surgical methods (such as using a pessary or estrogen replacement therapy). 

Prolapse and incontinence

One of the more common complications associated with prolapse is incontinence. This could be due to the weakening of the pelvic floor muscles, which help to both control urination and support the organs from prolapsing. If the prolapse also involves the bowel there may be difficulties with emptying the bowel, constipation or fecal leakage. Below are some bladder and bowel issues caused by prolapse.
  • Stress incontinence involves involuntary urinary leakage when sneezing, laughing or exerting yourself (e.g. heavy lifting).
  • Urge urinary incontinence refers to a sudden and intense urge to urinate, followed by involuntary leakage.
  • Urinary tract infection occurs when bacteria infect the urinary tract, causing symptoms such as incontinence, painful urination, traces of blood in the urine, etc.
  • Bowel incontinence is when you are unable to control bowel movements, causing fecal leakage. If related to rectocele type of prolapse, it is often due to constipation and difficulties emptying the bowel.
  • Anal prolapse is when the bowel comes out from the rectum causing fecal incontinence (more common amongst the elderly).
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