Pelvic Organ Prolapse

Pelvic organ prolapse occurs when pelvic structures, such as the bladder, uterus, or rectum bulge or protrude into the vaginal wall. This often results in pressure, discomfort and even vaginal pain.

An estimated 34 million women worldwide are affected by pelvic organ prolapse.

COMMON SYMPTOMS OF PROLAPSE

  • A bulge or lump in the vagina
  • Pulling or stretching feeling in the lower groin area
  • Difficult or painful intercourse
  • Vaginal pain, pressure, irregular bleeding or spotting
  • Frequent need to urinate (overactive bladder)
  • Difficulty emptying the bladder
  • Difficulty emptying bowels
  • A feeling that the bladder is not emptying completely (stress urinary incontinence)
  • Delayed or slow urine stream

WHAT CAUSES PROLAPSE?

Prolapse is causes by pelvic muscles and ligaments that have been weakened or damaged over time. The most common causes of prolapse are:

  • Age
  • Childbirth
  • Hysterectomy and other pelvic surgeries
  • Menopause
  • Obesity
  • Strenuous physical activity
  • Family history

 

TYPES OF PROLAPSE

  • Cystocele – This is a prolapse of the front wall of the vagina that often results in the bladder prolapsing into the vagina. Stress urinary incontinence is a common symptom of a cystocele.
  • Rectocele – This involves a prolapse of the back wall of the vagina. As a result, the rectal wall pushes against the vaginal wall, creating a bulge.
  • Enterocele – When the front and back walls of the vagina separate, the intestines push against the vaginal skin. An enterocele usually occurs following a hysterectomy.
  • Prolapsed uterus – The weakening of a group of ligaments at the top of the vagina cause the uterus to prolapse into the vagina
  • Vaginal vault prolapse - The top of the vagina falls toward the vaginal opening. This type of prolapse may occur following a hysterectomy.

DIAGNOSING PELVIC ORGAN PROLAPSE

Your doctor will begin the diagnostic process by taking a detailed medical history, performing a physical exam and by determining the strength and function of your pelvic floor muscles. Your doctor may also order additional diagnostic testing including:

  • A pelvic ultrasound
  • Bladder function test
  • Urodynamic testing, which are diagnostic tests that evaluate the function of the bladder and urethra and include uroflow, cystometrogram, EMG, pressure flow study, or videourodynamics.

 

NON-SURGICAL TREATMENTS FOR PELVIC ORGAN PROLAPSE

  • Physical therapyThe muscles of the pelvic floor are vital to keeping your pelvic organs in place. When women experience pelvic floor muscle weakness, prolapse and urinary incontinence often become an issue. Physical therapists will teach you how to perform pelvic floor exercises that will help tighten these important muscles. These exercises are often used to treat mild cases of prolapse or in conjunction with other prolapse treatment modalities.

  • Vaginal pessary - A vaginal pessary is a small device that is placed inside of the vagina to support the vagina and reinforce the pelvic floor muscles and surrounding pelvic organs. The pessary is a safe, minimally-invasive option for women and typically will relieve most, if not all, symptoms of prolapse.

  • Medical therapy - For certain women, your doctor may prescribe estrogen replacement therapy using a transvaginal estrogen cream to help strengthen the muscles and tissues in and around the vagina. Women naturally stop producing estrogen after menopause so estrogen replacement may provide relief. Your doctor will discuss the risks and benefits of this treatment and, based on your medical history and health, will determine if this option is right for you. 

 

SURGICAL TREATMENTS FOR PROLAPSE

Laparoscopic surgery to correct pelvic organ prolapse has provided many women with relief from the discomfort and pain associated with this condition.

  • Hysterectomy – Performed minimally invasively, this procedure to remove the uterus is used to treat uterine prolapse and is commonly performed on postmenopausal women or for women who do not want more children.

  • Vaginal vault suspension – This surgery is performed for women who suffer from vaginal vault prolapse. The vagina is attached to strong tissue in the pelvis or to the sacral bone located at the base of the spine.
     
  • Cystocele and rectocele repair – Through an incision in the vaginal wall, prolapsed organs are pushed up into proper place and secured, closing the vaginal wall to to keep the organ in its normal position.

  • Robotic Sacrocopopexy - Through small abdominal incisions, mesh is inserted and used to hold the pelvic organs in their correct, natural position. This minimally invasive surgery for total vaginal prolapse  is sometimes performed after a hysterectomy to hold the pelvic organs in place and provide support for the vagina.

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