Pelvic Organ Prolapse
NEARLY ONE-QUARTER OF AMERICAN WOMEN AFFECTED
Pelvic organ prolapse affects about 24% of women overall and 50% of women who have had a vaginal birth.
What is pelvic organ prolapse?
Pelvic organ prolapse is a condition in which the pelvic organs (bladder, uterus, or rectum) descend or “fall” onto the vaginal wall and may even bulge outside the vagina. In essence, it’s a type of “hernia” in which the organs dip into the vagina due to weakening of the muscles and connective tissues of the pelvis.
Types of Pelvic Organ Prolapse
Many women may have more than one type of prolapse and it may be classified as mild, moderate, or severe.
CYSTOCELE: the bladder falls into the vagina
RECTOCELE: the rectum bulges into the vagina
UTERINE PROLAPSE: the uterus sags into the vagina
ENTEROCELE: the small intestine bulges into the vagina
VAGINAL VAULT PROLAPSE: After a hysterectomy, the walls of the vagina fall in on themselves
Risk factors
Causes of pelvic organ prolapse include vaginal deliveries, a family history of prolapse, being post-menopausal, activities that cause repetitive pressure on the pelvis (constipation, chronic cough, obesity) and prior pelvic surgery such as hysterectomy.
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Treating Your Condition
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Non-Surgical Treatment of Pelvic Organ Prolapse
Most women with pelvic organ prolapse have few symptoms and require no treatment. However when symptoms become significantly bothersome, treatment is indicated. Non-invasive treatment options include:
Behavioral changes include weight loss, avoiding heavy lifting, correcting a chronic cough (quitting smoking), or preventing constipation that contributes to straining to have a bowel movement.
Pelvic floor exercises (Kegels) done consistently may help, although this has not been proven. Exercises cannot reattach vaginal support and reverse the prolapse, but strengthening pelvic floor muscles may help relieve symptoms or prevent prolapse from becoming worse.
A pessary is the most common non-surgical treatment for prolapse. It is a device worn in the vagina to help support the prolapsed organ.
Surgery for Pelvic Organ Prolapse
One in 9 women will undergo surgery for pelvic organ prolapse. Surgery may be performed through a vaginal incision, laparoscopic/robotically, and rarely via an open abdominal incision. The choice of a specific surgical procedure depends on your age, health status, type of prolapse, severity of prolapse and your desire to continue sexual activity. Your physician will discuss the surgical choices with you.
Cystocele and Rectocele Repairs ‑ This surgery is usually performed vaginally and lifts the prolapsed bladder or rectum back into place, and tightens the supportive muscles and ligaments. Your surgeon may also reinforce vaginal tissues with a tissue graft.
Colpocleisis – The prolapse is repaired by making the vaginal opening smaller so that the prolapse cannot protrude. This surgery is minimally invasive and long lasting, but often narrows the vagina to a point were sexual intercourse is no longer possible.
Sacral Colpopexy — Your surgeon uses a thin piece of surgical mesh to connect the vagina to the sacrum (tailbone). This procedure may be performed laparoscopically using the da Vinci Surgical System, also known as “robotic surgery”. The advantages of this approach are less pain, less scarring, a shorter hospital stay, quicker recovery and a greater success rate.
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