4. Types of Pelvic Support Problems
The main types of pelvic support problems and the pelvic organ that can cause bulging are as follows:
• Cystocele-bladder
• Vaginal vault prolapse with enterocele-vagina and small intestine
• Rectocele-rectum
• Uterine prolapse-uterus
• Combination

Cystocele
A cystocele, sometimes called anterior wall pro¬lapse, occurs when the bladder drops from its nor¬mal place into the vagina. Some cystoceles cause urine to leak when you cough, sneeze, lift objects, or walk. Large cystoceles may create a kink in the urethra and cause problems with the passing of urine. If this occurs, you may have to strain or push the bladder up by reaching into the vagina to pass urine. If there is a very large cystocele and if the bladder loses some of its ability to contract, it may not empty as completely as it should.

Small cystoceles are common. In most cases, they do not cause problems with urination and do not need surgery. If a cystocele is causing symptoms, your doctor can suggest ways to relieve them.

Urine may leak when there is a sudden increase in abdominal pressure caused by walking, jumping, coughing, sneezing, laughing, lifting, or making sudden movements. The amount of urine lost may be only a few drops. In other cases, it may be enough to require changing clothes or wearing pads.
There are many reasons why a woman may leak urine. In some cases, leakage of urine may be caused by a urinary tract infection, bladder problems, or other medical conditions. You should see your doc¬tor if leakage of urine is a problem for you. Your doctor can help you sort out whether a cystocele is causing the leakage.

Vaginal Vault Prolapse With Enterocele
Sometimes after hysterectomy (removal of the uterus), the top of the vagina loses its support and drops. This is called vaginal vault prolapse. The degree of prolapse varies. The top of the vagina may drop part of the way into the vagina and remain there, or it may extend part or all of the way through the vaginal opening. Women who have complete vaginal prolapse also may have problems with blad¬der and bowel function. Most women who have vaginal vault prolapse also have an enterocele. An enterocele is a type of support problem that forms when the small intestine drops through supporting tissue and bulges into the vagina. To diagnose an enterocele, a doctor may examine you while you are standing.

Rectocele
When the rectum bulges into or out of the vagina, it is called a rectocele. It is sometimes called a pos¬terior wall prolapse. It is caused by a weakness of the back wall of the vagina. A large rectocele may make it hard to have a bowel movement, especially if you are constipated. Some women must push the bulge back into the vagina to have a bowel movement.

Uterine Prolapse
When the uterus drops down into the vagina, it is called uterine prolapse. The distance the uterus drops may vary. Mild degrees of prolapse are com¬mon. They often do not cause symptoms and do not need surgery.
Women with more severe forms of this condition often will have a feeling of pelvic pressure or a pulling feeling in the vagina or lower back. The cervix (the opening of the uterus) may stick out from the vagina. This may cause discomfort or problems with sex. Uterine prolapse most often occurs when other pelvic organs also are out of place.

Combination
Although each problem occurs in different pelvic organs, they often occur at the same time.

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