Pelvic Prolapse: Understanding Symptoms, Causes & Treatment

Question
Dear Brenda,

I've had a very painful condition for about a year now.  I have switched doctors many times, and they have all given up on me.

The problem occured after a prolonged period of squatting. I was working on some house projects laying on the ground, and was squatting for hours at a time. When I stood up, there was a very sharp tearing pain inside my lower abdomen, between my vagina and urethra. Since then, the pain never went away. I have this constant pain as if something is going to fall out of my vagina. When the pain is severe, I could see a bulging tissue just inside the vaginal opening. Intercourse became extremely painful, and is now impossible. There is a lot of pain when urinating, with urinary retention. I experience urinary incontinence at times. The pain and the pressure goes away only if I am laying on my stomack, and it worsens if I am sitting or standing.

I've done numerous urine and PAP tests, and they all came back normal. It's only recently that I suspect I might have cystocele or a prolapse of some kind. I started to do pelvic muscle exercises which help a little bit. My doctors would not look into this problem because I am only 24 and have not given birth. They think a prolapse is not possible. But this problem is seriously affecting my life, and I don't know what to do at this point. Have you heard of condition familiar to what I am describing? Thank so much for your time.

Answer
Dear Cathy,

You have done your homework. The symptoms you describe do sound like those associated with a uterine prolapse. Most often this condition is associated with obstetrical trauma related to lacerations or prolonged labors/deliveries which weaken the musculature of the pelvic floor. However, more rarely, it can be caused by other factors which weaken those muscles (obesity, chronic lung disease, asthma - related to chronic coughing). And it occasionally occurs in young or nulliparous (no babies) women (estimates are about 2% for symptomatic prolapse).

The symptoms of uterine prolapse are:
-Pelvic heaviness or pressure
-Protrusion of tissue: A patient who reports of a "bulge" has been found to be a valuable screening tool for the detection of pelvic organ prolapse.
-Pelvic pain
-Sexual dysfunction, including dyspareunia, decreased libido, and difficulty achieving orgasm
-Lower back pain
-Constipation
-Difficulty walking
-Difficulty urinating
-Urinary frequency
-Urinary urgency
-Urinary incontinence
-Nausea
-Purulent discharge (rare)
-Bleeding (rare)
-Ulceration (rare)

To diagnose this condition, a complete pelvic examination is required, including a rectovaginal examination to assess sphincter tone. Physical findings may be enhanced by having a patient strain during the examination or by having you stand or walk prior to examination. Standing with an empty bladder may result in a 1-2 stage difference in the degree of prolapse noted on examination when compared to a supine (lying down) position with a full bladder. A mild uterine prolapse may be recognized only when a patient strains.

The fact that Kegel exercises are helping somewhat tends to further suggest that this may be exactly what is going on with you, as that is the first treatment for this condition. However, in some cases, surgery is necessary to repair the prolapse.

It is very disappointing to me that there is no doctor who will listen to your concerns. My suggestion is to try to find a new OB/GYN who has no history with you whatsoever. Simply go in with the list of symptoms you have experienced. The bulging you are able to note should be a red flag. The rest of the symptoms only support it. Explain that you are well aware that this does not typically happen to women who have not had children, but it is very real for you and has completely altered your life. Don't give up!

I hope this information has helped you and answered your question. I wish you well.

Brenda