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If you have a heavy feeling down there, or if your urine doesn’t feel cool when you urinate and you have a persistent urge to urinate, you may have a problem with your pelvic structure, not just fatigue. These symptoms are experienced by more women than you might think, but they’re not easily recognized and often kept to themselves.
hello. I’m Dr. Sangchul Hwang, an autonomic neurologist. Today, I would like to calmly explain what pelvic organ prolapse, including cystocele, is, why it happens, and how to recognize it.
Why is my bladder down, is it just a muscle problem?
In the doctor’s office, you’ll often be diagnosed with a descended bladder or a prolapsed uterus, but medications are often only temporary and surgery is often overwhelming. However, understanding this problem as simply weak pelvic muscles falls short. From a Chinese medicine perspective, it’s more accurate to understand these symptoms as the result of an imbalance in the body’s overall structure, which runs from the skull at the top of the head to the sacrum, the hip bone.
The pelvis is a structure, not just bones
The pelvis is more than just a bony structure; it’s the center that connects the upper and lower body and houses the organs. Inside a woman’s pelvis are her bladder, uterus, and rectum, and supporting them from below are the pelvic floor muscles. When this structure is stable, the organs can stay in place, but if any one part is weak, the entire balance is thrown off.
Changes after childbirth and aging
During pregnancy and childbirth, the pelvic floor muscles are stretched significantly, and when this is combined with hormonal decline and aging after menopause, the support for the organs becomes weaker. As a result, the organs shift downward, a condition known as pelvic organ prolapse. In addition, obesity, chronic constipation, repetitive strength training, and heavy lifting can increase abdominal pressure, further exacerbating symptoms.
Differentiate between cystocele, uterine prolapse, and rectocele
Pelvic organ prolapse can be categorized by location: bladder prolapse is characterized by a bulge in the front of the vagina, uterine prolapse is characterized by a palpable hard structure deep inside the vagina, and rectocele is characterized by a bulge in the back of the vagina. However, in clinical practice, all three often occur together, so a holistic assessment is important rather than a simple categorization.
The importance of the cranial-sacral structure
An important clinical perspective is to understand the skull and sacrum as a single axis. This structure is not just a connection of bones, but a key axis that regulates balance and tension throughout the body, with the sacrum in particular acting as a center of support for the pelvic organs. In real-world surgery, the sacrum is functionally important enough to be used as an important reference point.
Why does it feel like the bottom is falling out?
Stress and poor posture increase tension in the head, and this tension is transmitted down the spine, restricting the movement of the sacrum. This causes the pelvic structure to tilt and the organs to be pushed downward as the support for the organs is weakened. Therefore, the feeling of being pushed down is a result and the cause is more properly viewed as a balance issue in the entire body structure.
Influence of body shape and constitution
The reason why women who experience the same birth experience different levels of symptoms is due to differences in body shape and constitution. A flat waist or a curved back that has lost its curve puts constant strain on the pelvis, as does a squatting habit or a lopsided posture. In addition, constitutions that are prone to drooping qi, as described in Chinese medicine, may be more prone to these symptoms due to a lack of elasticity in the muscles and ligaments.
Real patient stories
In the clinic, it is not uncommon for patients to present with bladder symptoms and be found to have pelvic organ prolapse. In one case, a woman in her 60s was complaining of frequency and pain more than 30 times a day, and on closer examination, she was also experiencing a downward spilling sensation when she stood. This patient had more than just a bladder problem; she had pelvic floor muscle dysfunction and structural imbalance. Another patient had pain and frequency persisting after cystocele surgery because the organ was repositioned, but the muscle, nerve, and structural issues remained.
Let’s recap
Feeling like you’re falling down is rarely explained by a single cause and is often the result of a combination of pelvic structure, muscles, nerves, body shape, and constitution, as well as organ positioning issues. So if you’re experiencing these symptoms, it’s important to look at your overall balance, not just one specific area.
Don’t go it alone
If you’re reading this and see something that resembles your own symptoms, feel free to leave a comment rather than trying to figure it out on your own. We’d love to help put things in perspective.
