Pelvic Organ Prolapse

WHAT IS PELVIC ORGAN PROLAPSE?

Pelvic organ prolapse (POP) occurs when the muscles or ligaments in your pelvic floor are stretched or become too weak to hold your organs in the correct position. When this happens, organs such as the bladder, rectum and uterus can bulge (prolapse) into the vagina and sometimes past the vaginal opening. Imagine a hammock tied between two trees. Now imagine that same hammock after years of heavy use.

Causes

Potential causes of POP include:

Pregnancy
Childbirth
Menopause
And many more

WHAT TYPES OF PELVIC ORGAN PROLAPSE ARE THERE?

Cystocele: A cystocele forms when the upper vaginal wall loses its support and sinks downward. This allows the bladder
to drop. When a cystocele becomes advanced, the bulge may become visible outside the vagina. The symptoms caused by cystoceles can include pressure, slowing of the urinary stream, overactive bladder and an inability to fully empty the bladder.

Vaginal Vault Prolapse: This occurs when the uterine or vaginal support structures holding the upper part of the vagina are weakened. If the uterus is present, this is called “uterine prolapse.” Symptoms include pressure, pain, bladder infections and difficulty urinating.

Rectocele: A rectocele forms when the lower vaginal wall loses its support, allowing the rectum to bulge into the vagina. Rectoceles may cause difficulty with bowel movements — including the need to strain more forcefully, a feeling of rectal fullness even after a bowel movement, increased fecal soiling and incontinence of stool or gas.

Enterocele: An enterocele typically forms when the small intestine bulges through the top of the vagina after a hysterectomy, but not always. In some women, the intestine may slide between the back of the vagina and the rectum. The symptoms can be vague, including a bearing down pressure in the pelvis and vagina, and perhaps a lower backache.

WHO SUFFERS FROM PELVIC ORGAN PROLAPSE?

Pelvic organ prolapse is more common among women than you might think. The important thing to remember is you’re not alone. Did you know:

Up to 50% of women may suffer from POP.
POP afflicts over 3 million women in the United States.
1 in 9 women will need prolapse surgery in their lifetime.

There are many women out there just like you who experience pain and discomfort associated with prolapse. But you don’t have to continue living like this; options are available to you.

DO YOU HAVE PELVIC ORGAN PROLAPSE?

Have you experienced any of the most common symptoms of pelvic organ prolapse?

Pressure or discomfort in the vaginal and/or pelvic area
Diminished control in the bladder and/or bowels
Pain during intercourse

It’s always important to talk with a specialist sooner rather than later when you suspect you may be experiencing symptoms associated with pelvic organ prolapse. There’s no shame in joining the conversation and there is no guilt in putting your health first.

What are the treatment options for Pelvic Organ Prolapse?

Pelvic floor exercises to strengthen the pelvic floor, known as Kegels, may be adequate for mild cases. Another treatment option is a pessary, device worn in the vagina to provide support for the organs that have fallen (or prolapsed). Pessaries are typically fitted by healthcare professionals. If symptoms are still bothersome and can’t be managed with a pessary or other non-surgical options, surgery may be needed.

Recommended surgeries to treat Pelvic Organ Prolapse

If non-surgical treatments do not provide sufficient relief of your symptoms and your pelvic organ prolapse continues to cause pain, problems with bowel and bladder functions or if it interferes with your sexual activity, it might be time to discuss surgical options. The goal of any type of surgical treatment for prolapse is to repair the supporting tissue of the prolapsed organ or vaginal wall using either the patient’s own tissues or a surgical mesh. Surgeries can be performed either through the abdomen or the vagina. Surgeries performed via the abdomen may be performed laparoscopically or through open abdominal incisions. It’s important to discuss all of your options with your physician to determine which treatment plan is most appropriate for your specific medical situation.

Surgical procedures that use patients’ own tissues and ligaments to treat pelvic organ prolapse include Modified McCall culdoplasty, high uterosacral ligament suspension, uterosacral ligament fixation and sacrospinous ligament fixation.
Surgical procedures that use surgical mesh to treat prolapse via an abdominal incision include sacrohysteropexy or sacralcolpopexy.
Sometimes the surgical removal of the uterus (hysterectomy) may be recommended at the same time as a treatment option for pelvic organ prolapse.

How is surgical mesh used in the treatment of Pelvic Organ Prolapse?

Surgical mesh is a medical device that is generally used to repair weakened or damaged tissue. In urogynecologic procedures, surgical mesh is permanently implanted to reinforce the weakened vaginal wall to repair pelvic organ prolapse.