Pelvic organ prolapse occurs when structures of the pelvis, including the bladder, uterus, vagina, small bowel and rectum, descend or fall into or outside the vaginal canal. It thought to be caused by pregnancy, labor, and childbirth. However, obesity, respiratory problems, constipation and pelvic organ cancers may contribute to prolapse.
Current research is exploring the contribution of genetics to pelvic organ prolapse. Connective tissues, such as ligaments and tendons, may be inherently weaker in women who acquire pelvic organ prolapse or herniation.
Pelvic Organ Prolapse: Types & Symptoms
Symptoms of pelvic organ prolapse are dependent on the internal organ that is prolapsed.
Cystocele occurs when the bladder protrudes into the vagina. Women diagnosed with cystocele may experience pelvic pressure and involuntary loss of urine when coughing, sneezing, or lifting heavy objects. Some women may not be able to empty their bladder due to kinking of the urethra. This is often relieved by pushing the bulge back into the vagina
Rectocele occurs when the rectum protrudes through the back wall of the vagina. A rectocele can cause pelvic pressure, constipation, and an uncomfortable feeling during intercourse. Some women report the need to splint or press down on the bulge to begin a bowel movement.
Enterocele occurs when the small intestine protrudes into the vagina. Women who have enterocele may experience pelvic pressure, lower backache, and an uncomfortable feeling during intercourse.
A vaginal vault prolapse is caused by tears or detachment of the top of the vagina from its attachments to the bony pelvis, which cause the front and back of the vaginal wall to fall. Vaginal vault prolapse can occur following a hysterectomy – the surgical removal of a woman’s uterus.
Uterine prolapse occurs when the pelvic muscles become weak. This can cause the vaginal opening to widen. This can cause the uterus to drop and allows the cervix, or neck of the uterus, to fall into the vaginal canal. A uterine prolapse can cause pelvic pressure, lower backache, and an uncomfortable feeling during intercourse.
Pelvic Organ Prolapse: Treatments
Treatment for pelvic organ prolapse usually depends on the severity of the symptoms and how much these symptoms are interfering with quality of life or daily activity. Treatments may include behavioral, mechanical, medical, or surgical.
Behavioral treatments rely on two important factors:
- A knowledgeable health professional who can provide the educational training and positive reinforcement to the patient.
- A patient who is motivated and able to perform the treatment(s).
In other words, a patient must be taught to follow the treatments correctly and on a regular basis in order to obtain the best chance for success. Behavioral treatments for pelvic organ prolapse include pelvic muscle exercises or Kegel exercises. When done correctly and regularly, these exercises can strengthen the muscles that help support the pelvic organs. They should be taught properly by a trained professional and must be practiced regularly. They are not difficult and can be done anywhere and at any time once properly learned.
Electrical stimulation is for women who have trouble contracting or tightening the pelvic muscles, or women who have very weak muscle strength due to muscle or nerve damage.
Mechanical treatments involve devices that are inserted into the vagina to provide support. A pessary is one form of this nonsurgical device. It is a small plastic (silicone) device that is placed in the vagina to prevent the vagina or uterus from prolapsing. Similar to dentures or contact lenses, the pessary requires cleaning and care to avoid problems. Women may be taught to remove, clean, and replace pessaries at home. Others choose to have their pessary care done through their doctor’s office.
Medication will not cure or reverse prolapse, but it may reduce existing symptoms or help prevent prolapse. Two types of medication are:
- Estrogen therapy
- Hormone replacement therapy
When disturbing symptoms cannot be satisfactorily improved with pessaries or pelvic muscle strengthening, pelvic reconstruction surgery is advised. Surgery is considered the best treatment for pelvic organ prolapse. About 85% of the patients who have surgery performed have no recurrence of the condition. Various surgical procedures have been developed to correct uterine and vaginal wall prolapse. The surgical plan is customized to consider a woman’s level of activity, general health, history of prior surgery and desire to have a sexually functional vagina.
Mesh use in Prolapse and Incontinence Surgery
Scientific evidence over the last 25 years suggests that the tissues of women with prolapse and incontinence are weaker and more prone to failure following surgery. At Magee, we have been augmenting our prolapse and incontinence surgeries with materials that make the tissues stronger for over 2 decades. In addition, under the direction of Dr. Moalli, we are world leaders in the behavior of biomaterials following surgical placement. In surgeries for urinary incontinence, we utilize a wide pore mesh that acts as a scaffold to rebuild the pubo-urethral ligament – a ligament that is compromised in many women with incontinence. Once your tissue grows into the scaffold, the new ligament will act to prevent the leakage of urine that occurs with cough, laugh, sneeze, walking, jogging and other activities. In Women with prolapse, we also employ mesh to reconstruct ligaments that used to provide support to the pelvic organs. We are keenly aware that many women may be hesitant to proceed with a surgery that utilizes mesh; however, because of our experience, the doctors at Magee not only know when a mesh may be appropriate for you but they also know what material to choose for your surgery and how it needs to be placed and tensioned for a good surgical outcome. While no surgery is risk free, the number of women experiencing a complication after a mesh surgery at our institution is extremely low.