Pelvic Prolapse

Many women's pelvic organs change as they age. They may have a feeling of pelvic pressure or heaviness. It may feel like "something is falling out of the vagina." These symptoms may be caused by pelvic support problems. Although these problems may begin with childbirth, women may notice them even more as they age.

Common Symptoms of Pelvic Organ Prolapse:

• Loss of bladder or possibly bowel control (incontinence)
• Difficulty completely emptying your bladder
• Feeling very full in your lower belly
• Increased need to urinate
• Problems with bowl movement, such as constipation
• Feelings of pelvic or vaginal heaviness, bulging,fullness and/orpain, or a feeling that something is "dropping"
• Feeling a pull or stretch in your groin area or pain in your lower back.
• Recurrent bladder infections
• Excessive vaginal discharge
• Pain or lack of sensation during sex

Causes of Pelvic Organ Prolapse

Your uterus, vagina, bladder and rectum are held in place by a web of muscles and connective tissues. As these muscles and connective tissues weaken, pelvic organs can shift and prolapse into the vagina.

Major Risk Factors Include:

• Vaginal Delivery/li>
• Obesity
• Menopause
• Loss of muscle tone with aging
• Genetic

Types of Pelvic Organ Prolapse

Below are several different types of pelvic organ prolapse:

Bladder

A cystocele or “dropped bladder” is the most common type of pelvic organ prolapse, occurring when tissues and muscles that hold the bladder in place are stretched or weakened. As the wall of the vagina stretches or loses its attachment to the pelvis, the bladder drops into the vaginal opening.

Urethral prolapse

or urethrocele, is commonly developed with bladder prolapse. When the muscles and tissues around the urethra weaken, the urethra can curve and widen causing it to press against the wall of the vagina.

Intestines

A small bowel prolapse or enterocele is common in women who have had hysterectomies and no longer have a uterus. The lack of a uterus, plus weakened tissues and muscles holding the small bowel, can cause the intestines and the top of the vagina to push into the lower vagina.

Rectum: A rectocele occurs when the back wall of the vagina loses its support due to stretched or weakened tissues and muscles. This can cause the rectum to move from its natural position and protrude into the vaginal opening.

Uterus

Uterine prolapse occurs when the cervix bulges down into the vagina due to weak pelvic muscles and ligaments.

Treatments for Pelvic Organ Prolapse

Depending on the severity of the prolapse and the associated symptoms, Pelvic organ prolapse can be treated with a variety of methods, including nonsurgical and surgical procedures.

Nonsurgical treatment options

Behavioral/Muscle Therapy

If symptoms are mild, therapy often starts with Kegel exercises to help strengthen the pelvic floor muscles.

Pessary

This device can be inserted into the vagina to support the pelvic area and help relieve mild symptoms of pelvic organ prolapse, including incontinence. Your doctor may recommend using vaginal estrogen along with the pessary. In some instances, a pessary may make urinary incontinence worse; if this happens, see your doctor to discuss other treatment options.

Biofeedback

In this method, the patient exercises the pelvic floor muscles while connected to an electrical sensing device. The device provides “feedback” to help you learn how to better control these muscles. Over time, biofeedback can help you use your pelvic muscles to decrease sudden urges to urinate and lessen certain types of pelvic pain.

Estrogen replacement therapy

Estrogen replacement therapy replaces hormones that a woman’s body should be making or used to make. Taking estrogen may help to limit further weakening of the muscles and other connective tissues that support the uterus.

Surgical treatment options:

Pelvic reconstruction surgery is often minimally invasive, and in most cases can be done through the vagina. Vaginal surgeries are typically associated with less pain after surgery, faster healing, and a better cosmetic result. Depending on the severity and type of prolapse that you have, abdominal surgery may be required. Laparoscopic and robotic operating techniques offer minimally invasive approaches to abdominal surgery by using small abdominal incisions and greatly reducing recovery time.

Reconstructive surgery to reposition the prolapsed organs may be recommended when non-surgical methods are unsuccessful.

• Repair of the bladder (cystocele) or urethra (urethrocele).
• Repair of the rectum (rectocele) or small bowel (enterocele).
• Repair of the vaginal wall (vaginal vault suspension).

Synthetic Mesh Repair

Using very small incisions inside the vagina, the surgeon repositions the prolapsed organs and secures them to surrounding tissues and ligaments using a soft mesh – a material similar to that used for abdominal hernia repair.

Posterior and Anterior Colporrhaphy

These procedures involve folding and then suturing, or stitching, the back (posterior) or front (anterior) wall of the vagina to support prolapsed organs.

Colporrhaphy can be effective for patients with pelvic organ prolapse; however, up to 40% of colporrhaphies fail to treat symptoms, and 29% of patients require repeat surgeries to treat their symptoms effectively.

Robotic Surgery

Doctors at Stone Oak Women’s Center are trained to perform Robot-assisted laparoscopic surgery utilizing the da Vinci® Surgical System. Through this system, they are now able to offer a minimally invasive option for complex surgical procedures.

Pelvic organ prolapse is a common and treatable condition. Please talk to your doctor to discuss treatment options and how you can get back to feeling normal again and regaining your lifestyle.