Many women aren’t aware of pelvic prolapse until it happens to them. Others think it’s an inevitable part of growing older. It’s true that pregnancy, childbirth and menopause increase every woman’s chance for prolapse. Each can stretch and weaken the muscles and connective tissue of the pelvic floor. When that happens, the pelvic organs (bladder, small bowel, rectum and uterus) can drop down from their natural position and bulge into the vagina.
It can be scary when you first notice it in the shower—an uncomfortable bulge protruding from your vagina. It’s a tell-tale sign of pelvic organ prolapse (POP). Many women have to push the bulge back into their vagina to urinate or have a bowel movement. It can be uncomfortable just sitting. You may experience other symptoms, too—vaginal pain or pressure, bleeding or spotting, urinary incontinence and a pulling feeling in the groin. For women who are still sexually active, prolapse can have a devastating effect on their love life by making intercourse painful. Fortunately, there are several good ways to fix prolapse.
Pelvic organ prolapse occurs when tissues that hold the pelvic organs in place become weak or stretched due to pregnancy, childbirth, menopause, obesity and natural aging. When that happens, one or more of the pelvic organs (bladder, small bowel, rectum or uterus) bulge into the vagina. Nearly half of all women will experience pelvic prolapse at some point during their lifetime.
There are five types of pelvic organ prolapse—cystocele, enterocele, rectocele, uterine and vaginal vault. Each form of prolapse presents its own challenges.
Cystocele prolapse
Occurs when the supportive tissue between the bladder and vaginal wall weakens and stretches—allowing the bladder to bulge into the vagina.
Enterocele prolapse
Occurs when muscles and tissues that hold the small bowel in place weaken and allow the small bowel to descend and bulge into the vagina.
Enterocele prolapse
Rectocele prolapse occurs when the wall of fibrous tissue that separates a woman’s rectum from her vagina weakens and allows the rectum to bulge into the vagina.
Uterine prolapse
Occurs when ligaments and other connective tissue supporting the uterus inside the pelvic cavity weaken—allowing the uterus to slide down into the vagina. The vagina may also be pulled down and even turn inside out.
Vaginal vault prolapse
Occurs when pelvic and vaginal tissues and muscles weaken until the upper portion of the vagina sags and loses its normal shape. It drops down into the vaginal canal or outside the vagina. This type of prolapse may happen on its own or along with a cystocele, enterocele or rectocele prolapse. It happens most frequently in women who have had a hysterectomy.
Urology Partners offers the latest vaginal, robotic, and non-invasive treatment options. We help women get back to doing all the things they love without discomfort, worry or embarrassment.
Pessary Device Vaginal Prolaspe Repair Robotic Prolaspe Repair
This non-invasive approach uses a soft rubbery silicone form known as a pessary. Inserted into the vagina, the pessary gently pushes the prolapsed organ back to its correct position to keep it from bulging into the vagina. Pessaries come in a variety of shapes and sizes, and work for most types of prolapse. Some are shaped like a doughnut or ring, while others are shaped like a pacifier or cube. Each is custom-fit to the woman’s unique anatomy. Pessaries are a good treatment option for older women who are no longer sexually active and for women who don’t wish to undergo surgery in the near future or ever.
Most women find wearing a pessary very comfortable. Some patients simply wear it during the day, remove it at night to wash it, and then put it back in the next morning. Other women may wear their pessary for up to 10 weeks before they temporarily remove it for washing. Women who want or need help inserting and removing their pessary for washing can visit the UP office for assistance every 10 weeks or so.
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 can be made through the vagina (also known as a vaginal colporrhaphy with apical suspension). The repair can be reinforced with tissue from the patient or biologic graft material that’s been treated for safe use in humans. Although mesh was also an option until recently, it is no longer used for vaginal prolapse repair.
Read our blog post by Dr. Cannon-Smith "Put Your Prolapsed Organs Back Where They Belong"
When there is a high degree of prolapse involving more than one pelvic organ, a robot-assisted sacrocolpopexy procedure is typically required to restore the vagina to its normal position and function. It may also be required in women undergoing a hysterectomy for uterine prolapse who need their pelvic organs suspended. When the uterus is still intact, UP prolapse surgeons work in cooperation with a gynecologist to take care of everything all at once rather than subject the patient to two separate surgeries. In patients whose uterus has already been removed, a UP surgeon handles all aspects of the procedure to surgically suspend the pelvic organs.
During the procedure, four to six small incisions are made in the abdomen to lift the prolapsed organs and secure them with soft synthetic fabric. Women typically spend one night in the hospital, are advised to take one to two weeks off work, and abstain from sex and other strenuous activities for six weeks. The procedure delivers good results. Studies show that five years after surgery, women who undergo a sacrocolpopexy enjoy a 95 to 98 percent success rate.
