Women’s bodies endure so much in the normal course of life—pregnancy, childbirth, menopause, hysterectomy, aging. While the spirit may be resilient, the tissue that holds the pelvic organs in place can have a hard time standing up to the demands. Over time, these tissues stretch and become weak. When they do, the bladder, small bowel, rectum or uterus can slip down toward the vagina—a condition known as pelvic organ prolapse (POP).
Something’s Not Right Down There
Discovering your organs are out of place can be alarming! “Most women notice a bulge of tissue protruding from their vagina when they’re showering or using the toilet,” explains Tracy Cannon-Smith, M.D., a Urology Partners surgeon certified in female pelvic medicine and reconstructive surgery. “In some cases, a woman may have to push the bulge in vaginally to urinate or have a bowel movement. Other women say they feel like they’re sitting on a ball.”
There are other signs, too. Vaginal pain, bleeding, spotting or feeling like you have pulled a groin muscle are all symptoms of POP. Experts estimate that nearly 50 percent of all women will struggle with pelvic organ prolapse at some point during their lifetime. “For a woman who is still sexually active, prolapse can be embarrassing and prevent intimacy with her partner,” Dr. Cannon-Smith adds. “Fortunately, there are several ways to fix prolapse—vaginally and robotically.”
Diagnosing the Problem
Often, women who suffer from pelvic prolapse also have hidden incontinence issues they don’t know about. “Bladder prolapse can mask leakage,” Dr. Cannon-Smith explains. “Generally, the more the bladder drops, the more it blocks urine from leaking.”
Urodynamics testing identifies any leaking ahead of surgical repair. “We don’t want to return a woman’s bladder to its normal position only to find that she leaks urine every time she coughs or sneezes,” she says.
During urodynamics testing, a catheter is used to fill the bladder. Video and still images are captured while the bladder is being filled and emptied—allowing the physician to actually look at the sphincter muscles and leakage. It allows me to determine which type of surgery is best for the patient,” Dr. Cannon-Smith says.
Putting Everything Back Where It Belongs
Depending on the severity of the prolapse and the organs involved, prolapse is remedied using one of two surgical methods—vaginal prolapse repair or robotic prolapse repair.
Vaginal Prolapse Repair
This minimally invasive vaginal approach is generally used for less severe cases of prolapse, including cystocele prolapse (bladder bulges into the vagina) and rectocele prolapse (rectum bulges into the vagina). Repair of the prolapse is made through the vagina (also known as a vaginal colporrhaphy with apical suspension).
“With the vaginal prolapse repair, I am able to lift the bladder to its natural position and secure it using either native tissue harvested from the patient or other biological materials,” Dr. Cannon-Smith says. “If a woman waits until her prolapse is really severe, she eliminates this option because the repair may not hold if there is a high degree of prolapse.”
Robotic Prolapse Repair
When there is a high degree of prolapse, a robot-assisted procedure known as robotic sacrocolpopexy repair is usually required.
“A woman may have had a hysterectomy or be experiencing a prolapse of the vaginal vault—the back wall of the vagina. Everything is coming out. These patients do best with a sacrocolpopexy,” Dr. Cannon-Smith explains. “We also do robotic sacrocolpopexy on women who are undergoing a hysterectomy for uterine prolapse and need their pelvic organs suspended. In that case, we work in cooperation with the patient’s gynecologist to take care of everything at once rather than two surgeries.”
During the procedure, four to six small incisions are made in the belly (similar to laparoscopic surgery) to lift the prolapsed organ and secure it with graph material. Studies show that five years after surgery women who undergo a sacrocolpopexy enjoy a 95 to 98 percent success rate.
With both the vaginal and robotic procedures, women usually spend one night in the hospital.
Dr. Cannon-Smith recommends that women take one to two weeks off work to recover if they have a desk job, and abstain from sex and other strenuous activities for six weeks. She also warns women to avoid certain things following prolapse repair.
“You don’t want to have chronic constipation where you’re bearing down on your pelvic floor with hard stools,” she says. “Women also need to be careful about lifting weights. We’re not saying don’t keep yourself in good shape, but it’s not a good idea to use heavy weights while doing exercises like squats where your legs are wide apart and your pelvis is exposed.”
Are you struggling with symptoms of pelvic organ prolapse?
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