The pelvic floor is a group of muscles, ligaments, and connective tissues that form the base of the pelvis and support the bladder, uterus, vagina, and rectum. When these structures weaken or are damaged — through childbirth, aging, hormonal changes, chronic straining, or genetic predisposition — the organs they support can descend from their normal positions. This descent is called pelvic organ prolapse. When the muscles and fascial supports of the urethra are compromised, the result is stress urinary incontinence — leakage of urine with physical effort.
Pelvic floor disorders are common. Prolapse affects approximately one in three women who have had children, and the lifetime risk of requiring treatment for prolapse or incontinence is estimated at 20 percent. Yet the majority of affected women do not discuss these symptoms with their physicians — because they assume the symptoms are a normal consequence of childbirth or aging, because they are embarrassed, or because they do not know that effective treatment exists.
None of those assumptions is correct. Pelvic organ prolapse and stress incontinence are not inevitable features of having had children. They are not something that must simply be accepted. And they have a spectrum of treatment options — from conservative and non-surgical through definitive surgical repair — that restore pelvic support, eliminate or significantly reduce bothersome symptoms, and improve quality of life in ways that are consistently significant and durable.
Pelvic floor disorders produce a characteristic cluster of symptoms that are often attributed to other causes or dismissed as normal aging. Recognizing these symptoms as pelvic floor-related is the first step toward effective management.
- A sensation of pelvic pressure, heaviness, or fullness — often described as feeling like something is falling out
- A visible or palpable bulge at the vaginal opening — present at rest or with straining
- Pelvic pressure or discomfort that worsens throughout the day and with prolonged standing or activity
- Pelvic pressure that improves when lying down
- Difficulty with or inability to insert and retain a tampon
- Leakage of urine with coughing, sneezing, laughing, lifting, or exercise — stress urinary incontinence
- A sudden compelling urge to urinate that is difficult to defer — urge incontinence
- Increased urinary frequency or difficulty completely emptying the bladder
- Difficulty with bowel emptying — needing to manually support the vaginal wall to have a bowel movement
- Low back or pelvic discomfort associated with activity or prolonged standing
- Discomfort or reduced sensation during intercourse
Any of these symptoms warrants a gynecologic evaluation. Prolapse and incontinence are not inevitable and not untreatable — and the earlier they are evaluated, the broader the range of management options available.
Most pelvic floor symptoms are appropriately addressed through a scheduled appointment. Contact our office promptly if you experience:
- Complete inability to urinate with significant lower abdominal or pelvic discomfort
- A large bulge at the vaginal opening that cannot be manually reduced with discomfort or difficulty urinating
- New pelvic floor symptoms following recent pelvic surgery or trauma
Pelvic organ prolapse is named for the organ or compartment that has descended from its normal position. Understanding which type of prolapse is present guides the most appropriate treatment approach.
Cystocele — Bladder Prolapse
A cystocele occurs when the wall between the bladder and the vagina weakens, allowing the bladder to drop and bulge into the vaginal canal. It is the most common form of prolapse. Symptoms include a bulge in the front wall of the vagina, pelvic pressure, urinary frequency, difficulty emptying the bladder completely, and stress incontinence. Learn more about bladder prolapse →
Uterine Prolapse
Uterine prolapse occurs when the ligaments and muscles supporting the uterus weaken, allowing it to descend into or through the vaginal canal. It ranges from mild — where the uterus is slightly lower than normal — to complete prolapse, where the uterus protrudes outside the vaginal opening. Symptoms include pelvic pressure, a bulge, low back discomfort, and difficulty with urination or bowel function. Learn more about uterine prolapse →
Rectocele — Rectal Prolapse Into the Vagina
A rectocele occurs when the wall between the rectum and the vagina weakens, allowing the rectum to bulge into the back wall of the vaginal canal. Symptoms include a posterior vaginal bulge, difficulty with bowel emptying, the need to manually support the vaginal wall during defecation, and a sense of incomplete evacuation. Rectocele is often present alongside cystocele in women with more significant pelvic floor dysfunction.
Vaginal Vault Prolapse
Vaginal vault prolapse occurs after hysterectomy, when the top of the vagina — the vault — descends into or through the vaginal canal. It represents loss of apical vaginal support and is often accompanied by cystocele or rectocele. Surgical repair of vaginal vault prolapse addresses the apical support deficit and the accompanying prolapse compartments simultaneously.
Stress Urinary Incontinence
Stress urinary incontinence (SUI) is leakage of urine triggered by physical effort — coughing, sneezing, laughing, lifting, or exercise — that raises intra-abdominal pressure beyond what the urethral support mechanism can contain. It is caused by weakness of the urethral sphincter, loss of urethral support, or both. SUI is one of the most treatable pelvic floor conditions and has effective options from conservative management through minimally invasive surgical procedures. Learn more about stress incontinence →
Pelvic floor care at Lapeer Women’s Health is led by Dr. Ramona D. Andrei, MD, PhD, FACOG — with a comprehensive approach from conservative management through surgical repair, individualized to each patient’s anatomy, symptoms, and goals.
Conservative Management
Conservative management is the starting point for most patients with pelvic organ prolapse and stress incontinence. Pelvic floor physical therapy strengthens the muscles that support pelvic organ position and urethral closure. Pessary fitting provides mechanical support that reduces prolapse symptoms without surgery and is appropriate for women who prefer non-surgical management or who are not currently surgical candidates. Learn more about pessary treatment →
Hormonal Support
Local vaginal estrogen is an important adjunct to pelvic floor management in postmenopausal women. Genitourinary atrophy from estrogen deficiency weakens the supportive tissues of the vaginal walls and worsens both prolapse and incontinence symptoms. Restoring local tissue health with vaginal estrogen improves the response to conservative management and surgical repair, and is recommended for most postmenopausal women with pelvic floor disorders.
Surgical Repair
For women with significant prolapse or incontinence that has not responded adequately to conservative management, or who prefer definitive treatment, surgical repair is highly effective. Dr. Andrei performs minimally invasive pelvic reconstructive surgery for prolapse repair and stress incontinence procedures at our affiliated Michigan hospitals. Learn more about when prolapse needs surgery →
Pelvic floor disorders are common, but common does not mean inevitable or untreatable. Women who leak urine every time they cough, who feel pelvic pressure throughout the day, or who are aware of a vaginal bulge have access to management options that can eliminate or significantly reduce those symptoms — from pelvic floor therapy through pessary through surgery, depending on what is right for them.
The conversation about those options starts with a clinical evaluation that takes your symptoms seriously and assesses your pelvic anatomy specifically. Dr. Ramona D. Andrei and the team at Lapeer Women’s Health are here for that evaluation — at both our Lapeer and Rochester Hills offices, without a referral required.
Pelvic Floor Disorders and Prolapse
Our team at Lapeer Women’s Health provides comprehensive pelvic floor evaluation and treatment — from conservative management through surgical repair — at both our Lapeer and Rochester Hills offices. No referral required.
Schedule a Gynecologic VisitThe information on this page is intended for educational purposes only and does not constitute medical advice. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.