Pelvic Organ Prolapse in Men: Symptoms and Treatments to Improve Pelvic Health

Pelvic organ prolapse in men occurs when the weakened pelvic floor fails to support the organs, causing the rectal wall to shift. Learn more about this topic and understand how it is possible to strengthen these muscles under specialized guidance.

Pelvic organ prolapse occurs when the bladder or rectum move out of their normal positions due to the weakening of the muscles and ligaments responsible for keeping them in the correct places. Advanced age, obesity, surgeries, and injuries in the pelvic region are the main causes. Understand more below.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse happens when the pelvic floor is not strong enough to keep the bladder, rectum, large intestine, small intestine, and uterus in their proper places, causing these organs to move out of their normal position. In women, the uterus and bladder can protrude through the vagina.

Pelvic organ prolapse in men is less common and usually involves the rectum or the bladder.

Regardless of sex, prolapse is the result of a weakened pelvic floor. This loss of strength may be due to multiple childbirths in women. Other causes include advanced age, obesity, pelvic injuries, and chronic constipation. Meanwhile, prostate removal is a common factor in pelvic organ prolapse in men.

The Importance of Pelvic Floor Health for Men

The pelvic floor is a set of muscles, tissues, and ligaments that keep each organ in this region in the correct position.

A helpful analogy is to compare it to the floor of a house. Just as a house’s floor provides support, the pelvic floor holds up what is above it, i.e., the bladder and rectum in men.

Although it is more often associated with women, the pelvic floor is also important for men’s health. Here’s why:

• It provides support for the spine, helping with stability and posture;
• Urinary and fecal control;
• Strong pelvic muscles contribute to erectile function and ejaculation quality.

Can Men Have Pelvic Organ Prolapse?

Yes, men can experience pelvic organ prolapse, but they are less prone to it for the following reasons:

1. The male pelvic bones are narrower and stronger, providing greater support to the bladder and rectum. The female pelvis is wider to facilitate childbirth, making that structure more fragile, which generally occurs after multiple births;
2. Pelvic organ prolapse is more common in women because they have a uterus, a large and heavy organ that can descend when the pelvic floor is weak;
3. During pregnancy and vaginal delivery, the pelvic floor undergoes significant pressure, and since men do not become pregnant, they do not experience that strain;
4. The decrease in estrogen during menopause causes pelvic muscle weakness. The reduction in testosterone in men does not impact this structure as intensely.

What Are the Most Common Types of Pelvic Organ Prolapse in Men?

The most common types of pelvic organ prolapse in men involve the bladder and the rectum. Check out:

• Rectocele: the rectal wall shifts into the anal canal or toward the perineum, the area between the anus and the genitals. Male rectal prolapse is more common in older men and also in cases of prostatectomy (prostate removal);
• Bladder prolapse: the muscles and ligaments in the pelvic region fail to support the bladder, causing it to drop. Men with this condition feel pressure in the lower abdomen and have difficulty urinating.

Bladder Prolapse

Bladder prolapse in men is a pelvic floor disorder caused by the natural weakening of the pelvic muscles that can occur with aging and other factors. Learn which ones:

• Chronic constipation (difficulty passing stools);
• Obesity;
• Pelvic injuries or trauma;
• Neurological diseases.
• Pelvic surgeries.

Rectal Prolapse

Rectal prolapse in men happens when the rectum, the final portion of the large intestine, protrudes through the anus. The causes of male rectal prolapse are the same as for bladder prolapse: aging, obesity, pelvic injuries and trauma, neurological diseases, and pelvic surgeries.

Causes of Pelvic Floor Prolapse in Men

Learn what leads to pelvic organ prolapse in men:

1. Chronic constipation: straining to defecate puts pressure on the pelvic floor, which fails to hold the bladder in place, causing it to move downward;
2. Obesity: excess weight increases pressure on the pelvic floor and consequently shifts the bladder;
3. Pelvic injuries or trauma: automobile accidents or incidents during sports activities can weaken pelvic muscles due to impact;
4. Neurological diseases: multiple sclerosis and Parkinson’s disease affect the nerves of the pelvic floor and those responsible for bladder function;
5. Pelvic surgeries: prostatectomy, prostate removal due to benign prostatic hyperplasia (enlargement of the gland) or prostate cancer treatment, can compromise pelvic muscles and ligaments.

What Are the Symptoms of Pelvic Floor Prolapse in Men?

Get to know the symptoms of pelvic organ prolapse:

1. Urinary disorders:

• Weak or intermittent urine stream;
• Difficulty initiating urination;
• Sensation of a full bladder;
• Frequent urinary tract infections;
• Increased urinary frequency;
• Involuntary urine loss when coughing, sneezing, or lifting heavy objects.

2. Fecal incontinence

• Excessive straining to defecate;
• Fecal leakage;
• Needing to evacuate multiple times;
• Sensation of incomplete evacuation;
• Visible protrusion during or after a bowel movement.

How Is It Diagnosed?

Pelvic organ prolapse is diagnosed using this protocol:

1. Medical history: a discussion with the patient to understand symptoms and identify risk factors, such as chronic constipation or a history of pelvic surgeries;
2. Urine function test: the physician may ask the patient to bear down or cough to check for stress urinary leakage;
3. Imaging exams: ultrasound, MRI, CT scan;
4. Cystoscopy: a procedure performed with a cystoscope to visualize the inside of the bladder and urethra;
5. Urodynamic test: an exam that measures the function of the lower urinary tract, bladder, urethra, and pelvic floor muscles. It includes assessing urine flow, evaluating the bladder’s storage capacity, analyzing pressure during urination, and examining pelvic muscle activity.

Recommended Treatments

Treatments for pelvic organ prolapse can be surgical or non-surgical:

1. Non-surgical

• Pelvic strengthening exercises, such as pelvic physiotherapy and Kegel exercises;
• Avoid physical activities with excessive load;
• If you are overweight, gradually reducing body weight when necessary can ease pressure on the pelvic floor;
• Medications, if there is associated urinary incontinence.

2. Surgery: pelvic reconstructive surgery to repair muscles and reposition the organs.

When to See a Urologist?

You should consult a urologist if you have difficulty urinating, urinary incontinence, frequent urinary tract infections, a feeling of heaviness or pressure in the pelvic region, or pain when urinating or during sexual activity.

Pelvic prolapse requires the supervision of a specialist. If you suspect you have this condition, schedule a pre-consultation for a medical evaluation tailored to your symptoms.