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Pelvic Organ Prolapse

Vagina, Pelvic Organ Prolapse, Menopause Center Los AngelesPelvic organ prolapse occurs when one or more pelvic organs fall from their normal positions. In mild cases, a slight bulge can be detected inside the vaginal canal.  In severe cases, the affected organ may push a lump of tissue past the vaginal opening.

Pelvic organs that may prolapse include:

  • Uterus
  • Top of the vagina, following a hysterectomy
  • Bladder – affects the front (anterior) wall of the vagina, also known as a cystocele
  • Rectum – affects the back (posterior) wall of the vagina, also known as a rectocele
  • The pouch of tissue between the uterus and rectum, sometimes including the small intestine, also known as an enterocele

Pelvic Organ Prolapse Symptoms

Pelvic organ prolapse can range from mild to severe.

While some patients with prolapse may not appear to have any symptoms, some common symptoms include:

  • Feeling of pressure or fullness in the lower abdomen
  • Aching or pulling sensations in the pelvis
  • Difficult urination or bowel movements
  • Pain or discomfort during sex
  • Visible or palpable protrusion of tissue through the vaginal opening

Organ Prolapse Treatment

If your condition is mild and isn’t causing any symptoms, then your condition may not require any treatment. If you’re experiencing only slight discomfort, then your doctor may recommend a conservative, non-surgical treatment plan.

Pessar

A pessary is a small, doughnut-shaped device made out of plastic or rubber that can be inserted into the vagina to lend extra support to the pelvic organs. Your gynecologist can insert the pessary for you the first time, and show you how to remove, clean, and re-insert the device on your own.

Kegel exercises

These are exercises designed to strengthen the pelvic floor muscles. They are easy to do and can be done anywhere, on your own time.  Simply squeeze the muscles you would use to stop the flow of urine, hold for 3 seconds, then release. Perform 20 repetitions of this exercise 3-5 times per day.

Weight loss

Overweight or obese women can relieve some of the pressure on their pelvic organs by losing some weight. Your doctor can talk to you about some healthy ways to lose weight with diet and exercise.

If your prolapse is more severe, you may want to discuss surgical treatment options with your doctor. Your age, medical history, and particular risk factors will influence the type and timing of your surgery. For example, if you plan on becoming pregnant in the future, you may wish to postpone surgery until after the pregnancy.

Surgery for Pelvic Organ Prolapse

Obliterative surgery

This procedure involves supporting the pelvic tissue by surgically closing off the vagina. After this procedure, you are no longer able to have penetrative vaginal sex.

Reconstructive surgery

In this approach, the goal is to place the pelvic organs to their original position and reconstruct the pelvic floor to provide more support to the organs. In most cases, sexual intercourse is still possible after you’ve made a full recovery.

Types of Reconstructive Surgery for Pelvic Organ Prolapse

There are several types of reconstructive surgery, which can be performed through an incision in the vagina, in the abdomen, or through laparoscopy.

Uterosacral ligament suspension and sacrospinous fixation

In this procedure, your pelvic organ(s) will be fixated or suspended using the surrounding tissues. It’s typically performed through the vagina, which can cut down on recovery time.

Colporrhaphy, anterior or posterior

This surgery involves strengthening either the front or back walls of the vagina with stitches, restoring support to the bladder or rectum. It is also commonly performed vaginally.

Sacrocolpopexy and sacrohysteropexy

Performed through incisions in the abdomen, these procedures involve suspending the prolapsed cervix or vaginal vault (in the case of hysterectomy) to a bone at the base of the spine. Although recovery time may be longer, there is less risk for lingering pain during vaginal intercourse.

Vaginally-placed mesh

In this procedure, the vaginal walls are supported by the placement of surgical mesh. This type of treatment carries risk of pain, infection, and erosion of the mesh over time. It’s generally only used when other procedures have failed to fix the problem, when abdominal surgery is too risky, or when the woman’s tissues have sustained significant damage.

Recovery from Reconstructive Surgery

Because the different surgical interventions are individualized to your case, full recovery times will vary. Generally speaking, you may need to take 3-5 weeks off work to rest and recover. During this time, you should avoid heavy lifting, strenuous exercise, and vaginal intercourse.

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