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Pelvic Organ Prolapse

Genital prolapse or pelvic organ prolapse is the protrusion of the pelvic organs into or out of the vaginal canal. Most cases are the result of damage or weakness to the vaginal and pelvic support tissues due to childbirth or due to chronically elevated intra-abdominal pressure. Several types of different types of pelvic prolapse exist, including cystocele, rectocele, enterocele and uterine prolapse.  Prolapse can occur individually or in combination with a prolapse of another pelvic organ. Generally more than one organ is involved. Patients typically notice a mass or protrusion from the vagina followed by pelvic pressure and backache.

Cystocele refers to the bladder drooping or sagging into the vagina.  This occurs because of a laxity in the top wall of the vagina.

Rectocele refers to the rectum pushing into and protruding out of the vagina.  This occurs because of a laxity in the bottom wall of the vagina.

Enterocele refers to the intestines pushing into and protruding out of the vagina.  This occurs because of a laxity at the apex of the vagina.  Thus usually occurs in women who have already undergone a hysterectomy.

Uterine Prolapse refers to the uterus dropping into the vagina or protruding out of it.  This occurs because of a laxity in the uterine suspension ligaments.

Symptoms of Prolapse.  These can range from absolutely no symptoms to large ball protruding out of the vagina cause urinary, bowel and sexual complaints.

Urinary Symptoms include urinary frequency, urgency, urge incontinence, decreased urine flow, difficulty initiating urinary stream, inability to fully empty the bladder, stress incontinence and recurrent urinary tract infections.

Bowel symptoms include fecal incontinence, urgency to have a bowel movement, straining to have a bowel movement, difficulty evacuating stool, applying manual pressure in the vagina to have a bowel movement and change in the consistency of bowel movements.

Sexual symptoms include incontinence during intercourse and pain with intercourse.

General symptoms include seeing or feeling a ball in the vagina, constant or intermittent vaginal pressure and low back pain especially with standing for long periods of time or with straining.

Diagnosis of the types of prolapse can generally be performed with a thorough physical examination.  Confirmation of the diagnosis can also be achieved with MRI, video urodynamics, cystoscopy and cystogram.

Treatment of Prolapse

We are very proud to offer the most advanced surgical techniques to treat all forms of prolapse (cystocele, rectocele and enterocele).  We provide minimally invasive surgical options that are performed through the vagina and do not require an abdominal incision.  Our outcomes offer superior success rates and low recurrence rates with minimal complications.

  • Pessary : A device inserted into the vagina to support the prolapsed organs.  Fitting and insertion of pessaries are performed in the comfort of our office.
  • Pelvic floor muscle exercises:  May be done in conjunction with pessary use. The exercise strengthens the muscles in the pelvic floor, and may enhance the ability to retain the pessary in the vagina.
  • Hormone replacement therapy:  Improves the quality of the vaginal tissue.

These measures may relieve symptoms and reduce the prolapse. However, some women may not want or tolerate pessary use, and some prolapses are not sufficiently relieved by pessaries, exercise, or hormonal replacement therapy, in which case surgery may be the desired option.

Surgery of Prolapse

Surgical options involve reducing the prolapse and, in many cases, restoring normal anatomy. There are many types of procedures available, each addressing a specific prolapse or defect.  Majority of patients will require a combination of the below surgeries.

Cystocele Repair .  An incision is made inside the vagina.  The bladder is replaced to its normal position.  A synthetic mesh is placed under the bladder and secured to dense ligaments within the pelvis.  Use of the mesh offers significantly lower failure and recurrence rates than with conventional cystocele repairs without the use of mesh.

Rectocele Repair .  An incision is made inside the vagina (not visible to the eye).  The rectum is replaced to its normal position in the pelvis and either a mesh is inserted or the pelvic floor muscles are reattached and tightened.

Enterocele Repair.  The apex and top most portion of the vagina is repaired by making a vaginal incision, reducing the abdominal contents, inserting a synthetic mesh and attaching the mesh to a very dense ligament termed the sacrospinous ligament.

Hysterectomy.  For most repairs a vaginal hysterectomy is required to provide long term results. This is usually done in combination with a cystocele repair and rectocele repair. This surgery is usually done in combination with a gynecologist.

If you are experiencing any of these signs of symptoms please call us for a consultation to further discuss treatment options.  Women no longer have to live with this embarrassing condition since treatment is safe, effective and easily tolerated.