Pelvic Organ Prolapse
Pelvic organ prolapse refers to the abnormal descent or 'dropping' of a pelvic organ such as the uterus (uterine prolapse), the vaginal wall attached to the bladder (cystocele), the vagina itself (vault prolapse) or the back wall of the vagina that is bordering the rectum (rectocele).
Patients vary in the severity and type of discomfort that they sense relative to the extent of prolapse. Symptoms of prolapse may include pressure in the pelvis, pain or discomfort with intercourse, and in some cases, a protrusion or bulge through the vaginal opening. Symptoms of bladder prolapse may include incomplete emptying of the bladder, need to strain to urinate, pelvic pressure, and in many cases, incontinence of urine. Symptoms of prolapse of posterior vaginal wall are similar, with patients demonstrating pressure and pain with bowel movements, constipation, and the need to press on the vagina or nearby so as to evacuate the stools adequately.
Prolapse is very common among all age groups but especially among the postmenopausal women who have experienced vaginal childbirth. The symptoms and protrusion associated with prolapse may be successfully corrected in many cases with conservative therapy, such as pessaries, or with surgical procedures. This depends on the patient’s desires and lifestyle and medical/surgical history.
Treatment by our urogynecologists is tailored to each patient's situation and desires. Options are offered and discussed, and a plan of care set accordingly.
There are many treatment options for prolapse. For some women, it can be monitored over time. However, this rarely helps resolve the prolapse. For patients who are bothered by their prolapse, some like to try physical therapy for the vagina. This is useful and nonsurgical, but the improvement may depend on how bad the prolapse is. Pelvic floor physical therapy involves exercises for the vagina guided by a trained therapist over the course of a few weeks. For cases where therapy may not help, a pessary may be used. A pessary is a plastic device that may look like a diaphragm and can support the prolapse. This method may not work in all cases, however depending on the location and extent of the prolapse, some patients may need a:
- Cystocele repair (commonly called bladder tuck)
- Rectocele repair (tuck on the posterior vaginal wall)
- Hysterectomy if the uterus is prolapsing and causing discomfort
- Cuff suspension (tuck of the top side of the vagina)
The surgery depends on which area is weak and how large the prolapse is. To repair the prolapse, it is important that your physician perform a support procedure to hold the vagina in place. Otherwise, recurrence of the prolapse might be rapid. Urogynecologists are specially trained on this type of repair and procedure. These techniques do not involve the use of mesh. They involve the use of your own tissues and stitches that dissolve over time, allowing your body to develop its own support system to help prevent recurrence of the prolapse.
These commonly performed procedures for prolapse of the top of the vagina include:
- Mayo-Mccall colpo-suspension
- Sacrospinous ligament fixation
- High uterosacral ligament suspension
Some patients may want to have their prolapse fixed using the robot. This is called sacrocolpopexy. This procedure involves the use of mesh that is attached around the vaginal walls and then to a strong ligament near the tailbone. This procedure, and despite its use of mesh, has never been part of FDA warning and is often considered a gold standard treatment for prolapse.
Our physicians are highly experienced and well trained so as to help you manage your prolapse and develop a care plan just for you.