Pelvic prolapse is the loss of support to the pelvic organs that surround the vagina and results in the excessive bulging (or dropping) of the bladder, urethra, rectum, vaginal walls or uterus into the vagina. Women with a form of this problem may complain of ‘something falling out of the vagina’, pelvic pressure, low back ache, and discomfort with intercourse, weak vaginal muscles, difficulty emptying the bladder or aching after bowel movements.
This problem can be associated with poor bladder or bowel control, and commonly follows multiple or large childbirth. There seem to be hereditary factors, and other factors, such as, smoking, obesity, decreased estrogen levels, constipation, lung disease, previous surgery, and certain occupations.
One or more of the pelvic organs can lose their support and fall out of place. When this occurs, it is called pelvic organ prolapse. The prolapse may be mild, moderate, or severe. You may have one or more types of prolapse. The main types of pelvic organ prolapse include the following:
Cystocele – The bladder sags into the vagina.
Urethrocele- The urethra sags into the vaginal canal.
Rectocele – The rectum bulges into the vagina.
Enterocele – The small intestine bulges into the vagina.
Lateral Vaginal Wall Defect- The sidewall of the vagina loses it’s support
Uterine Prolapse – The uterus drops into the vagina and can protrude from the vagina.
Perineal Defect- The perineal body between the vagina and rectum loses support and becomes thin.
Vaginal Vault Prolapse – The walls of the vagina lose support.
Possible Symptoms:
Feeling of fullness or pressure in pelvis
Sense that a “ball” or lump is protruding from the vagina
Problems passing urine or having a bowel movement
Urine leakage when you cough or use stairs
Pain or pressure in the low back area
Problems having sexual intercourse
Causes:
Vaginal childbirth
Hormonal changes that occur with menopause
Constant coughing (such as with bronchitis or smoking)
Heavy lifting
Chronic straining (such as with constipation)
Being overweight
Interestingly, many patients will have already undergone surgery or previous treatment for these problems and yet still have complaints. It has been shown that some surgical techniques have lower success rates and persistent or recurrent urinary incontinence and vaginal prolapse can occur in up to 40% of patients despite previous ‘corrective’ surgery. Newer approaches and techniques have dramatically improved the outcome for women with these problems, and this is our focus at Swor Women’s Care.
Your evaluation generally will include overall gynecologic exam, assessment of the 7 areas of pelvic support, and a measurement of resting and tensed pelvic floor tone, if appropriate. If problems are noted with pelvic support or muscle tone, then a basic treatment plan will be offered, with follow-up testing and treatment. A bladder health survey will be obtained if any bladder function problems exist. Any difficulties with bowel function, elimination or sexual function should be brought up and discussed for comprehensive and proper care.
Treatment of Pelvic Prolapse:
Home and Self-therapy
• Pelvic floor muscle exercises (Kegels), resistance exercise (Pelvic Toner).
• Avoid constipation by adding high fiber foods, increased water intake and natural stool softeners.
• Behavior modification- avoiding heavy lifting and straining, overweight, etc.
Non-surgical or conservative
• Biofeedback
• Electronic pelvic toning therapy
• Pessary devices- devices placed in the vagina to support the vaginal wall. A specific style, shape and size pessary can be fitted in the office. These devices require maintenance and office visits every 6-8 weeks for checking and cleaning. Sometimes patients will be taught how to remove the pessary for cleaning, and self-maintenance. The pessary can be a temporary treatment for prolapse or it can be used for many years. if desired.
Surgery
Our goal is to identify the specific sites of weakness in the vaginal wall and pelvis so that surgical repair, if needed, will provide the optimal result. This careful assessment and planning, in addition to a strict post-operative plan will minimize the risk of recurrence. The techniques that we rely upon are state-of-the-art. These operative repairs are sometimes combined with removal of the uterus, ovaries and repair for bladder and bowel incontinence, if necessary. Surgery is typically done at the hospital or short stay facility and usually has a 2 week initial recovery, followed by 2-4 more weeks of limited activity and “pelvic rest”. Most repair surgery is done through the vagina, in order to avoid large incisions and allow faster recovery and less post-operative pain. Women who have pelvic support problems should generally make a rule of avoiding strenuous activity and heavy lifting.
