Pelvic Organ Prolapse
What is it?
Prolapse is a medical condition when one or more of the organs located in the pelvis bulge or “drop” into the vaginal opening. This may include the bladder, the uterus, bowel or rectum. It typically progresses slowly over time but women will often notice “suddenly” when the bathe or perform personal hygiene.
- Heaviness in the vaginal area
- Seeing of feeling a “lump” protruding from the vagina
- Urinary symptoms-frequent urination, leakage of urine, difficulty getting the urine out
- Pain or discomfort during sexual intercourse
Why does it occur?
The overall cause of prolapse is from compromised support system of the pelvic organs. This includes the nerves, ligaments and musculature that normal supports these organs which may have been weekend over time by the following processes
Risk factors for prolapse:
- Pregnancy and childbirth
- Aging and menopause
- Prior pelvic surgery or trauma
- Family history of prolapse
- Heavy lifting and straining, constipation
How is it evaluated and why?
Your highly specialized urologist here will first perform a thorough evaluation of your symptoms as well as a comprehensive physical examination to evaluate your condition. Typically prolapse is diagnosed by physical examination but you may undergo some additional testing if you have significant urinary problems or you decide to pursue operative intervention for your problem.
What are my treatment options?
It is important to remember that prolapse is typically not a “dangerous” condition. One out of every three women may develop some degree of prolapse in their lifetime but only a small percentage of them will elect to have corrective surgery. Your urologist will discuss the treatment options and help you decide which one is right for you.
- Observation: Many women may choose not do anything about their prolapse. Often they may be reassured after their evaluation that their condition is not dangerous and decide that they can live with their symptoms.
- Pessary: Pessaries are a small rubber device that is inserted inside the vagina and act to mechanically hold up the prolapse. Placement is easily performed in the office and does not require surgery. There are many types, shapes and sizes of pessaries and your physician will help choose the appropriate one for you. These devices do require periodic removal and cleaning. They may be best suited for older patients, those not healthy enough or do not desire surgery or those still in their child bearing years.
- Pelvic Floor Exercise: Commonly known as Kegels, these exercises are performed daily to strengthen weak pelvic floor musculature. While they may not reverse the degree of prolapse you currently experience, they may prevent worsening of the condition and can help improve your symptoms. Like any exercise routine, they must be performed on a daily basis. Your physician may recommend additional therapy with a physical therapist that specializes in pelvic floor rehabilitation.
- Surgery: There a several excellent options to surgically correct your prolapse. While not a dangerous condition, symptoms from prolapse can significantly impact a patient’s quality of life. Your physician will discuss the risks, benefits and details of various surgical options:
- Vaginal Surgery: This may include a number of procedures to attempt to reconstruct the support system of the pelvis and are performed through incisions in the vaginal wall. In some cases a hysterectomy may be performed to provide the best chance of repair. Many of these procedures do not require a hospital stay and recovery is fast.
- Anterior/Posterior Colporraphy
- Sacrospinous ligament fixation
- Abdominal/Minimally Invasive Surgery: These approaches involve making incisions in the abdomen. This may be a “bikini” line incision or in the case of laparoscopic or robotic surgery, several small half inch incisions through which instruments are placed. In some cases a piece of synthetic material or mesh may be used to support the prolapsed vagina. Most of them do require an overnight stay in the hospital after surgery.
- Open sacrocolpopexy
- Robotic Surgery- sacrocolpopexy
- Robotic uterosacral ligament suspension