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Causes of uterine and bladder prolapse Risk factors Normally, the pelvic organs are held in place by the pelvic floor muscles and supporting ligaments, but when the pelvic floor becomes stretched or weakened, they may become too slack to hold the organs in place. A number of different factors contribute to the weakening of pelvic muscles over time, but the two most significant factors are thought to be pregnancy and ageing. Pregnancy and childbirth Pregnancy is believed to be the main cause of pelvic organ prolapse — whether the prolapse occurs immediately after pregnancy or 30 years later. The weight of the baby, and the physical trauma of labour and birth, stresses and strains the pelvic muscles and ligaments. Some of the tissues that become damaged during pregnancy never fully regain their strength and elasticity. |
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Women who have more than one child, whether the delivery is vaginal or by caesarean section, have a higher risk of prolapse than women who have one child or no children at all. Some people believe a caesarean section may be less damaging than a vaginal birth, but the majority of studies suggest that it is only slightly, if at all, protective. Studies also suggest that women who have children in close succession are at an even greater risk of prolapse because the muscles and ligaments are under constant strain. Ageing and the menopause Our muscles weaken as we grow older and the pelvic muscles are no exception. Although tissue damage is likely to have been caused much earlier, the ageing process further weakens the pelvic muscles, and the natural reduction in oestrogen at the menopause also causes muscles to become less elastic. Obesity, large fibroids or tumours Women who are severely overweight, or have large fibroids or pelvic tumours, are at an increased risk of prolapse due to the extra pressure this creates in their abdominal area. Chronic coughing or strain Chronic (long-term) coughing, from smoking, asthma or bronchitis for example, or the straining associated with constipation, increases a woman's risk of prolapse. A few bouts of bronchitis or constipation are unlikely to have a serious effect on your pelvic muscles, but if the stress and strain is ongoing, it may eventually weaken the pelvic support structures.
Heavy lifting can also strain and damage pelvic muscles and women in careers that involve regular manual labour or lifting, such as nursing, have an increased risk of prolapse. Genetic conditions Women with a genetic collagen deficiency (Marfan or Ehlers-Danlos syndrome) have an increased risk of prolapse even if they don't have any of the other risk factors. Collagen is a natural protein that helps keep tissues plump and elastic. Without it, the pelvic floor muscles become weak. Previous pelvic surgery Pelvic surgery, including hysterectomy or bladder repair procedures, may damage nerves and tissues in the pelvic area increasing a woman's risk of prolapse. Spinal cord conditions and injury Spinal cord injury and conditions such as muscular dystrophy and multiple sclerosis dramatically increase a woman's risk of prolapse. If the pelvic muscles are paralysed or movement is restricted, the muscles waste away and cannot support the pelvic organs. Ethnicity Studies show that white and Hispanic women have the highest rate of pelvic organ prolapse, followed by Asian and black women. There is little information about the incidence of prolapse in women of other (or more specific) ethnic groups. |
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Written by Tamara Beus and published in printed format (2003) by Women's Health
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Certain situations in pregnancy and birth further increase the likelihood and extent of damage, such as a large baby, a long labour and the use of forceps or extraction devices. There is conflicting information about the effect an episiotomy (a cut made in the base of the vagina during childbirth) may have on a woman's risk of prolapse, but the most recent research suggests it does not prevent pelvic floor damage.
Heavy lifting