The Pelvic Organs
The parts of the body affected by pelvic support problems include the urethra and bladder, the small intestine, the rectum, the uterus, and the vagina. The urethra and bladder lie in front of the vagina. The bladder receives and stores urine from the kidneys and expels it through the urethra (a short, narrow tube). The uterus is at the top of the vagina. Behind the uterus is a space within the pelvic cavity called the cul-de-sac. This space con-tains some of the small intestine. Along the back of this space is the rectum, which continues down the back of the vagina and ends at the anus. The perineum is the tissue between the opening of the vagina and the anus.

The pelvic organs are held in place by three types of support:

1. Layers of connecting tissue called endopelvic fascia
2. Thickened parts of the fascia called ligaments
3. A paired group of muscles that lies on either side and around the openings of the urethra, vagina, and rectum

When the tissues that support the pelvic organs are stretched and damaged, the organ that they support may drop down and press against the wall of the vagina. This causes a bulge. Sometimes the organ will drop down so much that the bulge sticks out through the vaginal opening.

Causes
The main causes of pelvic support problems are childbirth and aging. As the baby passes through the vagina during childbirth, the fascia and liga-ments may be damaged. They may become weak. In later years, when a woman goes through menopause, the loss of the female hormone estrogen may make these problems worse.

Sometimes pelvic support problems occur in women who have never had children. In these women, the cause may be:

• Weakening of the vaginal tissues after menopause
• Increases in abdominal pressure because of a chronic cough (often linked to smoking or lung disorders), heavy lifting, obesity, or constipation
• An inherited weakness of the tissues