Urogynecology & Pelvic Surgery

Pelvic Organ Prolapse Treatment

Services » Pelvic Organ Prolapse Treatment

Pelvic organ prolapse means that the female pelvic organs have fallen down from the normal position in the pelvis. The female pelvic organs, which include the bladder, the rectum and the uterus, are suspended into place with special ligaments, connective tissue and muscles. When these ligaments, connective tissue and muscles are damaged or atrophied over time, they no longer provide the needed support. As a result, the uterus may drop and the bladder and the rectum may herniate into the vagina causing a bulge that you may see or feel. Often times prolapse is the result of injuries sustained during childbirth, aging, a woman’s tissue composition, chronic coughing and heavy lifting, and obesity.


Evaluation for Pelvic Organ Prolapse

The initial evaluation for pelvic organ prolapse involves taking a detailed medical history accompanied by a physical examination. If a woman has urinary incontinence, overactive bladder, or urinary retention in addition to prolapse, the evaluation may require additional studies.


Treatment for Pelvic Organ Prolapse

Pelvic organ prolapse is rarely caused by serious underlying medical conditions such as cancer. Consequently, the choice of treatment usually depends on the severity of symptoms and how much these symptoms are interfering with one’s quality of life or daily activities. There are both surgical and non-surgical options.

Non-surgical options include:

Pessary: a small plastic device that is inserted into the vagina to place the fallen vagina, uterus and/or other pelvic organs in a more normal position. Pessarys come in many shapes and sizes. The most commonly used pessary looks like a diaphragm. A properly fitted pessary does not cause any discomfort and the woman is usually not even aware that she is wearing a pessary. A pessary should not restrict one’s daily activities and can be used for many years without problems. If so desired, a woman may learn to remove and reinsert her pessary for her own convenience. While a pessary can be a great non-surgical option for some women, other women with prolapse may not be able to retain a pessary in the vagina for various reasons.

Physical therapy: consists of exercises, such as Kegel exercises, to strengthen weak pelvic muscles. These exercises may be especially helpful in improving urinary leakage. Additionally, pelvic floor physical therapy may also include Biofeedback techniques that use positive feedback to improve pelvic muscle control.

Surgical Treatment:

Cystocele

A cystocele is caused by a defect in the anterior vaginal wall, which allows the bladder to protrude into the vagina. If the defect is severe enough, the bladder may protrude through the vaginal opening. Women who have a cystocele may experience pelvic pressure, involuntary loss of urine when coughing, sneezing, or heavy lifting, a protrusion from the vaginal opening, and an uncomfortable feeling during intercourse. Occasionally, women with a cystocele may also experience involuntary urine loss immediately after she feels the urge to urinate and/or urinary retention (unable to empty her bladder). Frequently, the involuntary loss of urine associated with coughing, sneezing, or lifting may become less severe because the urethra is kinked when the prolapse becomes severe.

A cystocele is repaired through a laparoscopic, vaginal or abdominal incision. If the patient’s own tissues are inadequate to perform a proper repair, a synthetic tissue may be placed to reinforce the repair. After surgery, the patient should refrain from strenuous or sexual activities for six to twelve weeks in order for the repair to heal properly.

Rectocele

A Rectocele is caused by a defect in the posterior aspect of the vagina allowing the rectum to protrude into the vagina. If the protrusion is large enough, it can be seen or felt outside the vagina. Women who have a rectocele may experience pelvic pressure, a protrusion from the vaginal opening, constipation, and/or an uncomfortable feeling during intercourse. This constipation frequently can be relieved by assuming a specified posture or by putting pressure on the posterior vagina.

A Rectocele is repaired through a laparoscopic, abdominal or vaginal incision. If the patient’s own tissues are inadequate to perform a proper repair, a synthetic tissue may be placed to reinforce the repair. After surgery, the patient should refrain from strenuous or sexual activities for six to twelve weeks in order for the repair to heal properly. She should also follow a high fiber diet and refrain from straining during bowel movements.

Uterine Prolapse

Uterine prolapse is caused by defect in the pelvic support tissues that allows the uterus to drop into the vagina. Women with uterine prolapse may experience pelvic pressure, lower backache, a protrusion fromthe vaginal opening, and an uncomfortable feeling during intercourse.

Uterine prolapse is usually treated by a hysterectomy in conjunction with a specialized procedure to provide vaginal support. The hysterectomy may be performed through a laparoscopic, abdominal or vaginal incision. After surgery, the patient should refrain from strenuous or sexual activities for six to twelve weeks in order for the incisions to heal properly.

Vaginal Vault Prolapse

Vaginal vault prolapse is caused by tears in the tissue, which attach the vagina to the pelvic sidewalls. When the top of the vagina falls down, it can cause the front and the back of the vagina to fall down as well. In its most severe form, the entire vagina can protrude outside the vaginal opening. This complete prolapse of the vagina is known as procidentia.

Vaginal vault prolapse is repaired through a laparoscopic, vaginal or an abdominal incision. The surgery may require using a piece of synthetic tissue to reattach the dropped vagina to ligaments along the bony pelvis. After surgery, the patient should refrain from strenuous or sexual activities for six to twelve weeks in order for the repair to heal properly.

Enterocele

An enterocele is caused by a defect in the vagina, which allows the small intestine to protrude into the vagina. If the protrusion is severe enough, it may be seen or felt outside the vagina. Women who have an enterocele may experience pelvic pressure, lower backache, a protrusion from the vaginal opening, and an uncomfortable feeling during intercourse.

An enterocele is repaired through a laparoscopic, vaginal or abdominal incision. After surgery, the patient should refrain from strenuous or sexual activities for six to twelve weeks in order for the repair to heal properly.

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