Pelvic Organ Prolapse

Pelvic organ prolapse is common in women, with 12% of US women having prolapse bothersome enough to undergo surgery. It can be a sensitive topic and some women may be reluctant to discuss it, but chances are you know several women with some type of prolapse. Not all prolapse is treated in the same way. With the help of specialists at Providence Saint John’s, you can find out which of the many options for treatment of prolapse is appropriate for you.

Pelvic organ prolapse occurs in women when pelvic muscles and tissue weaken and can no longer support the pelvic organs, causing them to bulge or drop into the vagina.

Here are some of the main types of pelvic organ prolapse:

Anterior Vaginal Wall Prolapse (Cystocele):

Anterior vaginal wall prolapse occurs when the wall between the bladder and the vagina is weakened, and that front wall of the vagina falls down.

Symptoms

  • A sense of pressure, heaviness, or bulge in the vagina
  • Frequent urination
  • Difficulty emptying the bladder completely
  • Recurring bladder infections
  • Loss of bladder control

Posterior Vaginal Wall Prolapse (Rectocele):

This type of prolapse occurs when the back wall of the vagina, the wall that separates the vagina from the rectum, stretches or becomes weakened.

Symptoms

  • A sense of pressure, heaviness, or bulge in the vagina
  • Straining during bowel movements and the feeling of not completely emptying the bowels

Apical Prolapse (Vaginal Vault Prolapse):

Apical prolapse is when the top of the vagina is not supported. In women who still have a uterus, this is the uterus and cervix that fall into, and sometimes through the opening of the vagina. Simply removing the uterus, without suspending the vagina, however, will not fix the problem. Even after a hysterectomy, the top of the vagina (called the vaginal cuff or vaginal vault) can still fall.

Symptoms

  • A sense of pressure, heaviness, or bulge in the vagina
  • Difficulty emptying the bladder completely
  • The need to push the prolapse back in before starting to pee
  • Ulcers and bleeding from the cervix or vaginal skin if it protrudes outside the vagina

Rectal Prolapse:

Rectal prolapse can occur when muscles and tissues detach from the rectal wall, allowing the rectum to fall out through the anus.

Symptoms

  • Blood from the protruding tissue, which may be mistaken for a hemorrhoid
  • Loss of control of bowel movements

Diagnosis

At Providence Saint John’s, your diagnosis will start with a thorough review of your medical history and a physical exam. Your doctor also may conduct additional tests, exams or procedures in diagnosing pelvic organ prolapse:

Pelvic exam: Your doctor will take measurements of the vagina with you standing up and laying down in order to identify which part of the vagina is prolapsed and how much. She will use a speculum and have you bear down to determine the extent of the prolapse.

Urodynamics: This test can assess urinary incontinence or difficulty urinating. It is often used for women considering prolapse surgery to give more information as to how their bladder may function following surgery.

Pelvic ultrasound: This procedure uses sound waves to examine the pelvic floor, reproductive organs and bladder. It is most commonly used for women who have postmenopausal bleeding, fibroids in the uterus, or ovarian cysts.

Treatment

Treatment for pelvic organ prolapse will depend on the severity of the symptoms, a woman’s general health, and her personal preferences. If surgery is planned, Providence Saint John’s offers the latest in minimally invasive surgery using laparoscopic techniques and the da Vinci robotic-assisted surgical system. Minimally invasive surgery involves several small incisions instead of a large one. Vaginal surgery hides all of the incisions in the vagina, so that there are no visible scars at all. The result is less pain, a shorter hospital stay and a quicker return to your normal daily activities.

Your comprehensive care team at Providence Saint John’s will work with you on a treatment plan that could include:

Nonsurgical Treatment

  • Quitting smoking: Smoking raises the risk of pelvic floor disorders in women.
  • Pelvic floor muscle training (PFMT): Pelvic floor muscle training, which is more than simply Kegel exercises, involves squeezing and relaxing the pelvic floor muscles to strengthen and better control them. Over time, Kegel exercises can help reduce urinary leakage, and may prevent progression of prolapse.
  • Pessary: A pessary is a device made of a medical-grade silicone that is inserted through the vagina to support pelvic organs and hold them in place. Similar to glasses or contact lenses, pessaries should be noticeable during insertion or removal, but otherwise you should be able to wear it comfortably. If your pessary is uncomfortable, it is likely not the appropriate size or shape.

Surgery

Surgery involves repairing the anatomy and restoring pelvic floor support. There are many ways to do this, depending on the type of prolapse and other factors. Women who choose to undergo surgery may or may not have the uterus removed, a hysterectomy, at the same time. Sometimes women have other procedures to treat or prevent urinary incontinence at the same time as prolapse surgery.

At Providence Saint John’s, our urogynecologists will take the time to explain all of your options, and make sure that those choosing surgery are fully informed and confident in their choice.