Piss Prolapse
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Piss Prolapse
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Cohee MW, et al. Benign anorectal conditions: Evaluation and management. American Family Physician. 2020;101:24.
Rectal prolapse. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/anatomic-problems-lower-gi-tract/rectal-prolapse. Accessed March 26, 2021.
Rectal prolapse. American Society of Colon & Rectal Surgeons. https://fascrs.org/patients/diseases-and-conditions/a-z/rectal-prolapse-expanded-version. Accessed March 22, 2021.
Tsunoda A. Surgical treatment of rectal prolapse in the laparoscopic era; A review of the literature. Journal of the Anus, Rectum and Colon. 2020; doi:10.23922/jarc.2019-035.
Varma MG, et al. Surgical approach to rectal procidentia (rectal prolapse). https://www.uptodate.com/contents/search. Accessed March 26, 2021.
Varma MG, et al. Overview of rectal procidentia (rectal prolapse). https://www.uptodate.com/contents/search. Accessed March 26, 2021.
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Rectal prolapse occurs when the rectum becomes stretched out and protrudes from the anus.
Rectal prolapse occurs when part of the large intestine's lowest section (rectum) slips outside the muscular opening at the end of the digestive tract (anus). While rectal prolapse may cause discomfort, it's rarely a medical emergency.
Rectal prolapse can sometimes be treated with stool softeners, suppositories and other medications. But surgery is usually needed to treat rectal prolapse.
If you have rectal prolapse, you may notice a reddish mass that comes out of the anus, often while straining during a bowel movement. The mass may slip back inside the anus, or it may remain visible.
The cause for rectal prolapse is unclear. Though it's a common assumption that rectal prolapse is associated with childbirth, about one-third of women with the condition have never had children.
Certain factors may increase your risk of developing rectal prolapse, including:
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One of the most uncomfortable—and awkward—conditions that afflicts women is pelvic organ prolapse. Normally, the pelvic organs—the bladder, uterus, vagina, and rectum—are supported and held in place by a group of muscles and tissues called the pelvic floor. When these muscles weaken over time, the pelvic organs can droop down and bulge out of the vagina.
In addition to the sensation of feeling an uncomfortable bulge in the vagina, you can experience symptoms such as
In pelvic organ prolapse, the pelvic floor
muscles weaken, causing one or more of the
pelvic organs to fall downward into or out of
the vagina.
How prolapse is named depends on which organ is affected:
Most of the time, pelvic organ prolapse is the result of carrying—and vaginally delivering—children, which weakens the pelvic floor. "The baby's head going through the vaginal canal stretches out the connective tissues," says Dr. May Wakamatsu, assistant professor at Harvard Medical School and division director of Female Pelvic Medicine and Reconstructive Surgery at Massachusetts General Hospital.
Getting older, being overweight, and having a condition that involves frequent coughing (which increases pressure in the abdomen and pelvis) also make a woman vulnerable to prolapse.
In pelvic organ prolapse, the pelvic floor muscles weaken, causing one or more of the pelvic organs to fall downward into or out of the vagina.
If you have pelvic organ prolapse, you'll notice a bulge at the opening of the vagina. The bulge isn't dangerous, but it can be very uncomfortable.
When the prolapse pulls the bladder downward, it bends the ureter (the tube through which urine exits the body). As a result, you might have trouble urinating fully. "It's like bending a garden hose," Dr. Wakamatsu says. Likewise, if the prolapse pulls the rectum downward, it can cause constipation.
As embarrassing as pelvic organ prolapse can be to talk about, it's something you need to discuss with your primary care physician or gynecologist. Letting it go can leave urine in your bladder, which can lead to urinary tract infections.
The first treatment your doctor might recommend is pelvic floor physical therapy, which may include Kegel exercises . You squeeze and release the muscles you use to hold in gas, which strengthens the muscles that help to support the pelvic organs.
It's important to do Kegels the right way, Dr. Wakamatsu says. A physical therapist can use techniques like biofeedback to help you find the right muscles to squeeze. Physical therapy with Kegels may be enough to relieve prolapse symptoms.
Your doctor might also recommend a device called a pessary . Pessaries are made from silicone and come in many different shapes. The pessary is inserted into the vagina to help support the prolapsed organs. It is usually fitted to you, and it's removable.
Surgery is an option for women who aren't comfortable with the idea of using a pessary, or who have tried it and found it didn't relieve their symptoms. There are several different types of surgery, based on the location and severity of the prolapse and other health issues. For women who have uterine prolapse, often a hysterectomy (removing the uterus) is recommended. Women who are at high risk for repeated prolapse may have a procedure called sacrocolpopexy, in which the surgeon works through small incisions in the abdomen to reposition the pelvic organs back where they should be.
"Women should lose weight if they're overweight. They should stop smoking because it can lead to repetitive coughing," Dr. Wakamatsu says. "And they should protect their pelvic floor by pulling in their lower abdominal muscles and tightening their pelvic floor muscles when they lift heavy objects."
Image: © FilippoBacci | GettyImages
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Pelvic organ prolapse
Nygaard, I., et al. (2008). Prevalence of Symptomatic Pelvic Floor Disorders in U.S. Women . JAMA; 300(11): 1311–1316.
Whitcomb, E.L., et al. (2009). Racial Differences in Pelvic Organ Prolapse . Obstetrics and Gynecology; 114(6): 1271–1277.
Kudish, B.I., Iglesia, C.B., Gutman, R.E., Sokol, A.I., Rodgers, A.K., Gass, M. et al. (2011). Risk Factors for Prolapse Development in White, Black, and Hispanic Women. Female Pelvic Med Reconstr Surg; 17(2): 80-90.
Patel, D.A., et al. (2006). Childbirth and Pelvic Floor Dysfunction: An Epidemiologic Approach to the Assessment of Prevention Opportunities at Delivery . American Journal of Obstetrics & Gynecology; 195 : 23–28.
Fonti, Y., et al. (2009). Post Partum Pelvic Floor Changes . Journal of Prenatal Medicine; 3(4): 57–59.
Sengupta, N., et al. (2013). Urogynecological Risk Assessment in Postmenopausal . Expert Review of Obstetrics & Gynecology; 8(6): 625–637.
Jones, K.A., et al. (2010). Pessary Use in Pelvic Organ Prolapse and Urinary Incontinence . Reviews in Obstetrics & Gynecology; 3(1). (PDF, 293.16 KB)
Food and Drug Administration. (2019). Urogynecologic Surgical Mesh Implants .
The Office on Women's Health is grateful for the medical review by:
Susan Meikle, M.D., M.S.P.H., Program Director, Pelvic Floor Disorders, Project Scientist, Pelvic Floor Disorders Network, Gynecologic Health and Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Cynelle (Murray) Kunkle, M.D, FACOG, Female Pelvic Medicine and Reconstructive Surgery, Mid-Atlantic Permanente Medical Group, P.C.
All material contained on these pages are free of copyright restrictions and maybe copied, reproduced, or duplicated without permission of the Office on Women’s Health in the U.S. Department of Health and Human Services. Citation of the source is appreciated.
Page last updated:
February 22, 2021
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