What is pelvic organ prolapse?
This is when one of the organs in the pelvis (the bladder, uterus, bowel or vagina) herniate or bulge into or out of the vagina. Pelvic organ prolapse occurs when the muscles and ligaments in the pelvis become weakened, and can be caused by pregnancy, childbirth, aging, chronic cough, chronic constipation, heavy lifting or straining, obesity, or connective tissue diseases.
There are several types of prolapse that have different names depending on which part of the body has dropped into the vagina:
- Cystocele (bladder)
- Rectocele (rectum)
- Uterine prolapse (uterus)
- Enterocele (small intestine)
- Vaginal vault prolapse (top of the vagina, in women who have had a hysterectomy)
When should I see a doctor?
You should get help if you have any of these symptoms:
- A bulge in the vagina
- Dullness, heaviness or significant pressure in the vagina
- Feeling like something is falling out of the vagina
- Discomfort during sexual intercourse
- Feeling like you can’t empty your bladder well
- Bladder leakage or urinary incontinence
- Bowel leakage or fecal incontinence
What are my treatment options?
The main treatments are pelvic floor exercises, pessaries and surgery.
Pelvic muscle exercises/Kegel exercises:
Pelvic floor exercises or “Kegel exercises” as they’re commonly called, are squeezing of the pelvic floor muscles to try and strengthen them. In order for them to work they need to be done consistently and there are lots of resources online to help you get started! Women with milder prolapse can get relief with these exercises.
If you need help performing these exercises, we can send you to a physical therapist who can help you target and strengthen your Kegel muscles.
Pessary:
Pessaries are vaginal devices (often silicone) that are placed inside the vagina and support the prolapsed organs. They come in all shapes and sizes, and our nurse practitioner, Deb Carr, is an expert in fitting and managing pessaries. A pessary is a good choice for women who wish to delay or avoid surgery. Some women are able to insert and remove the pessary on their own, others cannot and we are able to change it for them in the office.
Surgery:
For women who desire surgery, we offer the full range of minimally invasive surgical options. We can perform a laparoscopic, robotic or vaginal surgery, and we treat each patient individually. We talk with you about your preferences, goals, medical and surgical history, and degree of prolapse in determining which surgery is best for you.
Surgical procedures:
- Sacrocolpopexy (mesh-augmented)
- Non-mesh surgery (native tissue)
- Colporrhaphy (fixing the front or back walls of the vagina)
- Hysterectomy
- Uterine sparing surgeries (hysteropexy)
- Colpocleisis (vaginal closure)
