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- The buttocks singular: buttock are two rounded portions of the anatomy, located on the posterior of the pelvic region of primates including humans , and many other bipeds or quadrupeds, and comprise a layer of fat superimposed on the gluteus maximus and gluteus medius muscles.
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Pelvic organ prolapse involve a dropping down prolapse of the bladder, urethra, small intestine, rectum, uterus, or vagina caused by weakness of or injury to the ligaments, connective tissue, and muscles of the pelvis. Women may feel pressure that feels as if something is bulging out of their vagina or they are sitting on a ball, have a sense of fullness in their pelvis, or have problems with urination or bowel movements.
Pelvic organ prolapse occurs only in women and become more common as women age. During their lifetime, about 1 of 11 women needs surgery for pelvic organ prolapse. The pelvic floor is a network of muscles, ligaments, and tissues that act like a hammock to support the organs of the pelvis: the uterus, vagina, bladder, urethra, and rectum. If the muscles become weak or the ligaments or tissues are stretched or damaged, the pelvic organs or small intestine may drop down and protrude prolapse into the vagina.
If the disorder is severe, the organs may protrude all the way through the opening of the vagina and outside the body. Having an injury, as may occur during hysterectomy removal of the uterus or another surgical procedure. Frequently doing things that increase pressure in the abdomen, such as straining during bowel movements or lifting heavy objects.
Being pregnant and having a vaginal delivery may weaken or stretch some of the supporting structures in the pelvis. Pelvic organ prolapse is more common among women who have had several vaginal deliveries, and the risk increases with each delivery. The delivery itself may damage nerves, leading to muscle weakness. The risk of developing pelvic organ prolapse may be less with a cesarean delivery than with a vaginal delivery. As women age, the supporting structures in the pelvis may weaken, making pelvic organ prolapse more likely to develop.
Having a hysterectomy may also weaken the structures in the pelvis, increasing the risk of pelvic organ prolapse. Less common factors that may contribute include accumulation of fluid within the abdomen ascites, which puts pressure on pelvic organs , disorders of nerves to the pelvic floor, tumors, and disorders of connective tissue the tough, often fibrous tissue that is present in almost every organ, including muscles, and that provides support and elasticity. Some women have birth defects that affect this area or are born with weak pelvic tissues.
Pelvic organ prolapse is essentially a hernia, through which organs protrude abnormally because supporting tissue is weakened. Often, a woman has more than one type. In all types, the most common symptom is a feeling of heaviness, fullness, or pressure in the area of the vagina. A woman may feel as if she is sitting on a ball or that the uterus, bladder, or rectum is bulging or dropping out of her vagina.
Symptoms tend to occur when women are upright, straining, or coughing and to disappear when they are lying down and relaxing. For some women, sexual intercourse is painful. Prolapse of the rectum rectocele , small intestine enterocele , bladder cystocele , and urethra urethrocele are particularly likely to occur together. A urethrocele and cystocele almost always occur together.
Damage to the pelvic floor may affect the urinary tract. As a result, women who have pelvic organ prolapse may have problems controlling urination, resulting in urine leaking out involuntarily urinary incontinence or problems completely emptying the bladder urinary retention. A rectocele develops when the rectum drops down and protrudes into the back wall of the vagina. It results from weakening of the muscular wall of the rectum and the connective tissue around the rectum.
A rectocele can make having a bowel movement difficult and may cause constipation. Women may be unable to empty their bowels completely. Some women need to place a finger in their vagina and press against the rectum to have a bowel movement. An enterocele develops when the small intestine and the lining of the abdominal cavity peritoneum bulge downward between the vagina and the rectum. It occurs most often after the uterus has been surgically removed hysterectomy.
An enterocele results from weakening of the connective tissue and ligaments supporting the uterus or vagina. An enterocele often causes no symptoms. But some women feel a sense of fullness or pressure or pain in the pelvis. Pain may also be felt in the lower back. A cystocele develops when the bladder drops down and protrudes into the front wall of the vagina.
It results from weakening of the connective tissue and supporting structures around the bladder. When a urethrocele and cystocele occur together, they are called a cystourethrocele. In prolapse of the uterus, the uterus drops down into the vagina. It usually results from weakening of the connective tissue and ligaments supporting the uterus.
The uterus may bulge in the following ways:. At first, prolapse of the uterus may cause mild or no symptoms. When prolapses worsens, the first symptom most women report is feeling a bulge at the opening of the vagina. They may also have pain in the lower back or over the tailbone, difficulty having a bowel movement, and pain during sexual intercourse, as well as a feeling of heaviness or pressure—a feeling that pelvic organs are dropping out.
Total uterine prolapse can cause pain during walking. Sores may develop on the protruding cervix the lower part of the uterus and cause bleeding, a discharge, and infection. Women may have problems controlling urination, resulting in urine leaking out involuntarily urinary incontinence. Or women may not be able to empty their bladder completely or to urinate urinary retention.
Constipation can occur. In prolapse of the vagina, the upper part of the vagina drops down into the lower part, so that the vagina turns inside out. The upper part may drop part way through the vagina or all the way through, protruding outside the body and causing total vaginal prolapse. Usually, a cystocele or rectocele is also present. Total vaginal prolapse may cause pain while sitting or walking. Sores may develop on the protruding vagina and cause bleeding and a discharge.
Like prolapse of the uterus, prolapse of the vagina can cause problems with urination. Having a bowel movement may also be difficult. Doctors can usually diagnose pelvic organ prolapse by doing a pelvic examination with a speculum an instrument that spreads the walls of the vagina apart. A doctor may insert one finger in the vagina and one finger in the rectum at the same time to determine how severe a rectocele or enterocele is.
A woman may be asked to bear down as when having a bowel movement or to cough. She may be examined while standing with one foot on a stool. Procedures to determine how well the bladder and rectum are functioning may be done. For example, doctors often measure the amount of urine that the bladder can hold without leaking, the amount of urine left in the bladder after urination, and the rate of urine flow.
If a woman has a problem with the passage of urine or urinary incontinence, doctors may use a flexible viewing tube to view the inside of the bladder a procedure called cystoscopy or the urethra a procedure called urethroscopy.
These procedures help doctors determine whether drugs or surgery is the best treatment. If the bladder is not functioning well, women are more likely to need surgery. If sores in the vagina or on the cervix bleed or cause pain, doctors may need to take a sample and examine it to help them determine what treatment is needed.
Treatment of pelvic organ prolapse is based on the woman's symptoms. Treatment aims to improve quality of life. If symptoms are bothersome, treatment may include pelvic floor exercises, a pessary, and, if symptoms are severe, surgery. Pelvic floor exercises, such as Kegel exercises, can lessen bothersome symptoms, including stress incontinence, but do not affect prolapse itself. They tend to be most helpful if prolapse is mild. These exercises help by strengthening the pelvic floor muscles.
Kegel exercises target the muscles around the vagina, urethra, and rectum—the muscles used to stop a stream of urine. These muscles are tightly squeezed, held tight for about 1 or 2 seconds, then relaxed for about 10 seconds. Gradually, contractions are lengthened to about 10 seconds each. The exercise is repeated about 10 times in a row. Doing the exercises several times a day is recommended. Women can do Kegel exercises when sitting, standing, or lying down.
Some women have difficulty contracting the correct muscles. To determine whether they are contracting the correct muscles, women can contract pelvic floor muscles two or three times while urinating.
If they contract the correct muscles, the flow of urine stops in midstream. If women need additional help, pelvic floor physical therapy may be recommended. Pelvic floor therapy includes techniques that make learning the exercises easier, such as the following:. Cone-shaped inserts placed in the vagina, which help women focus on contracting the correct muscle.
Biofeedback devices, which may use special sensors that show pelvic floor muscle contractions on a computer screen. Electrical stimulation a health care practitioner inserts a probe, which transmits an electrical current to make the correct muscle contract.
If prolapse is causing symptoms, a device called a pessary may be inserted into the vagina to support the pelvic organs. Pessaries are especially useful for women who are waiting for surgery or who do not want or cannot have surgery.
The pessary can lessen symptoms but is not a cure. A pessary may be shaped like a diaphragm, cube, or doughnut. Some can be inflated. A doctor fits the pessary to the woman by inserting and removing different sizes until the right size is found. In some countries, pessaries may be available over the counter. A pessary must be periodically removed and cleaned with soap and water. Women are taught how to insert and remove the pessary for cleaning. If they prefer or if they are unable to clean and replace the pessary themselves, they may go to the doctor's office periodically to have the pessary cleaned.