Lowering of the pelvic floor and organs

General information

When the pelvic floor is lowered, a weakness of the pelvic floor muscles leads to a lowering of the pelvic floor including the pelvic floor organs: uterus (uterus), Bladder and rectum. Usually the muscles and ligaments in the pelvic floor area hold the organs in place and prevent them from falling.
However, if the muscles and supporting ligaments are pressed down, the organs cannot be held either.

The lowering of the pelvic floor can also occur after the uterus has been removed, in which case the vaginal stump typically subsides. The likelihood of lowering the pelvic floor increases with age and is particularly high during the menopause.

causes

The lowering of the pelvic floor can have various causes.

Usually there is an injury to the pelvic floor birth in front. So are many vaginal births, respectively heavy births a risk factor for developing pelvic floor subsidence.

But also Obesity, weakness of the connective tissue in this area or excessive or chronic strain on the pelvic floor may be the cause. Even the regular one Carrying heavy objects must be mentioned here, as wearing it also puts a chronic strain on the pelvic floor.

The occurrence of lowering of the pelvic floor is also typical Menopause. The cause are then transformation processes in the tissue of the pelvic floor. These transformation processes are favored by the reduced estrogen production during menopause. Keep playing too genetic factors a role.

Symptoms

A slight decrease the pelvic floor can initially no symptoms cause.

If, on the other hand, the lowering is more pronounced, a strange feeling of relaxation or one Feeling of pressure in the area of ​​the pelvis.

In the case of a strong decrease, even the tissue of the pelvic floor or the uterus can be seen and felt between the labia.
In this case there is a Prolapse of the uterus in the vagina in front. Usually there is also a strong one Foreign body sensation in the area of ​​the vagina. This strong form of the pelvic floor depression can also lead to other symptoms, such as problems with defecation Intestines and bladder (involuntary passing of stool or urine) or Discomfort during intercourse to lead.

Also Pain by irritating nerves in the area are possible. Furthermore, it can lead to a premature urge to urinate and thus to the toilet (Urge incontinence) come. Even with a small filling it happens because of the lack of attachment the bladder to the urge to urinate.

The quality of life is severely impaired by this severe form of pelvic floor depression.

Please also read our page Urinary incontinence.

diagnosis

First should be an accurate anamnese are collected: the most important thing is an existing one Foreign body sensation and Pelvic or vaginal painpassing stool or urine involuntarily (Incontinence) or a feeling of pressure in the lower abdomen.
According to the anamnesis is a examination important: here a Ultrasonic of the small pelvis and abdomen as well as a position check of bladder, rectum and uteruswhich can also change their position due to the lowering of the pelvic floor.

Also one gynecological check the vagina and possible foreign bodies in this area is useful. In addition to the gynecological, a rectal exam on the Intestines respectively. The severity of the subsidence of the pelvic floor and any existing one can also be determined from the clinical examination Prolapse the uterus can be assessed and classified using a score.

In complex cases, a MRI be important for imaging.

therapy

Depending on the degree of depression of the pelvic floor, another form of therapy must be selected.

At first, however, attempts are always made to treat the pelvic floor depression conservatively. Slight lowerings do not necessarily have to be operated on, while severe lowering of the pelvic floor requires an operation.

Medicinal:
In addition to gymnastics, a cream with estrogens can also be applied to the vaginal area. This can help relieve symptoms.

This article may also be of interest to you in this regard: Pelvic floor training

surgery

Strong pelvic floor subsidence can, however, with physical therapy are not adequately treated, in these cases or when the training with pelvic floor exercises fails, is usually one surgery necessary for the treatment of pelvic floor subsidence.

This involves a reconstruction of the pelvic floor Attachment target of the surrounding organs. For this operation there is different surgical proceduresthat can be applied. The OR access can be controlled via the vagina or about the belly respectively.

Some large clinics, such as university hospitals, also offer a surgical procedure over the modern one DaVinci robot on. The principle of the operation is similar in most cases: the aim is to fix the displaced organs in their original position, the pelvic floor muscles are gathered and the vagina is fixed in its original position. In addition, a type network be introduced, which then the support function of the Musculature takes over.
A removal of the uterus may be necessary in some cases, but nowadays people try to preserve the uterus depending on the patient's wishes.

forecast

Even after a treated pelvic floor subsidence, a new one can develop Urinary incontinence come. The risk for this is approximately up to 20%.

prophylaxis

To prevent lowering of the pelvic floor is regular physical therapy makes sense. Gymnastics with exercises to strengthen the pelvic floor muscles can also serve as a prophylaxis against lowering of the pelvic floor.
Especially with women who Risk factors for a lowering of the pelvic floor, prophylaxis can help to counteract the development of the lowering of the pelvic floor.

Gymnastics and sports

Slight subsidence of the pelvic floor can result physical therapy often adequately treated. The aim of physiotherapy, but also of pelvic floor training or pelvic floor exercises, is to strengthen the Musculature of the pelvic floor.

There are also therapy methods in which one learns to consciously control the muscles of the pelvic floor, for example in the event of urine loss urethra to be able to consciously close by contracting the muscles.
This process is called biofeedback. But it is important that the exercises that are learned in physiotherapy also continued at home become. Because only a continuous one Training the pelvic floor muscles can achieve success. In summary, it can be said that every sport you do strengthens the pelvic floor and therefore regular exercise can also serve as a good prophylaxis.

Pelvic floor programs train the pelvic floor muscles more specifically and can therefore also be recommended. After a pregnancy there are often special gymnastics programs for the regression of the uterus. Women who take advantage of this show a lower risk of subsequent pelvic floor sagging.

For more information, please also read our page Pelvic floor training.

pregnancy

Ask as already described vaginal births represent a risk factor for the development of a sagging pelvic floor.

In fact, during the birth process, one occurs strong loosening and stretching of the tissue, which is therefore a lowering of the Musculature can favor. The lowering of the pelvic floor can not only occur after one pregnancy, but also during pregnancy occur.

During pregnancy there is a strong enlargement of the uterus, which almost reaches the end Sternum can be enough. This additional Weightthat weighs down on the pelvic floor can stretch tissue and the Lowering the pelvic floor to lead.