Pelvic Organ Prolapse Repair
Pelvic organ prolapse, also known as POP, is a type of pelvic floor disorder which affects the group of muscles surrounding, suspending, and protecting your pelvic organs. The pelvic organs include the uterus, bladder, rectum, small bowel, and vagina. It is possible to have more than one pelvic floor disorder. If you are having issues you think may be related to a prolapse, make sure to seek diagnosis and treatment from an experienced professional.
What is Pelvic Organ Prolapse?
Pelvic organ prolapse is a condition that results in one or more of the pelvic organs shifting out of place and bulging or dropping down. It is typically caused by the weakening of the muscles and tissues that support these organs, also known as the pelvic floor or pelvic floor muscles. As severity increases the pelvic organs can move into the space typically occupied by the vagina causing discomfort or problems with bladder function, sexual function, and/or bowel problems.
Signs and Symptoms of Vaginal Prolapse
Depending on which organs are affected, the signs and symptoms of pelvic organ prolapse may vary. Pelvic organ prolapse is a common condition that occurs in roughly 33% of women, most of whom have given birth vaginally. Some women have no POP symptoms, but others report these common symptoms.
Pelvic Pressure or "Heavy" Pelvic Organs
A sensation that often accompanies the condition is described by women as a “heaviness” or a fullness in their pelvic region. This could also be in conjunction with a feeling of pressure in the same area. This pressure is sometimes accompanied by aching or spasms in the pelvic floor muscles.
Seeing or Feeling a Bulge in the Vagina
Many women also report feeling — or in some cases, seeing — a bulge in their vagina or pelvic area. This is caused by the prolapsing organ protruding within or outside of the vagina. It can also feel like sitting on a ball or an egg. When a bulge can be seen or felt, it is important to know that what is being seen or felt is the skin of the vagina. The organs themselves, bladder and bowel, are rarely visible at the vaginal opening as they are covered by the skin of the vagina.
Discomfort with Sexual Intercourse
Another potential symptom of pelvic organ prolapse is discomfort or pain during penetrative sex. This can occur even when there is no pelvic pain otherwise. Because the organs may drop into the vaginal canal, this can cause an obstruction and lead to further discomfort during intercourse. Patients sometimes complain of an urge to urinate during intercourse of state that their partner is “hitting something” causing painful intercourse for both the patient and her partner.
Urinary Incontinence
A very common sign is urinary incontinence as evidenced by leaking during certain activities. This is common because of the weakened pelvic muscles. Leaking urine can occur while sneezing, coughing, laughing, vigorous exercise, or sexual intercourse.
Incontinence of Stool or Constipation
In addition to urinary incontinence, women may also experience bowel incontinence for the same reasons. Constipation is also both a potential cause for and symptom of POP due to straining and constant pressure on the abdominal wall.
How is Pelvic Organ Prolapse Diagnosed?
In order to best treat pelvic organ prolapse, it must be properly diagnosed by your physician. This is done by reviewing your medical history and performing a pelvic exam as needed. During the exam you may be asked to strain or cough; this is done to evaluate the support and movement of the vaginal walls as well as to determine the presence of severe incontinence or risk for incontinence after surgical repair .
Common Causes of Vaginal Prolapse
Childbirth is one of the biggest causes of vaginal prolapse, especially for those with multiple vaginal deliveries. Any activity that strains and weakens the pelvic floor can lead to prolapse, including repeated lifting of heavy objects, chronic constipation, chronic constipation, and aging.
Types of Vaginal Repairs
Any surgery for pelvic organ prolapse can be referred to under the broad term of pelvic floor repair. Procedures vary depending on which organs are affected, the severity of prolapse (determined by pelvic exam), and the goals of the patient. It is also common to perform multiple repairs during the same surgical procedure.
Vaginal Surgery
Surgery to repair or reinforce the weakened layers between the bladder and the vaginal tissues is referred to as anterior repair. When the anterior (front) wall of the vagina bulges, there is at least a 60% chance that the top of the vagina also moves with straining. This is called apical prolapse. Nearly all types of prolapse (prolapsed uterus, bladder, and bowel) can be repaired using vaginal surgery and avoiding incisions on the abdomen. The aim of this procedure is to relieve the symptoms of vaginal bulging and to improve bladder function.
Laparoscopic Surgery
Laparoscopic surgery is minimally invasive and avoids large incisions by using small surgical instruments to perform the procedure. Laparoscopic surgery to repair pelvic prolapse is called colposuspension. This procedure involves four to five small incisions (1 – 1.5 cm) in the abdomen, through which surgeons suspend the vagina and associated pelvic organs. When a graft or synthetic mesh is used, the surgery is called sacrocolpopexy. This is considered the gold standard of repair for apical prolapse. Laparoscopic surgery can be performed with or without the assistance of a robot, such as the DaVinci surgical robot.
Mesh Augmented and Non-Mesh Options
Surgical re-suspension of the vagina is often done through a combination of stitches and a supportive mesh graft. The mesh may be used in more severe cases to strengthen the anterior vaginal wall, however it is not always necessary, particularly because it has a risk of complication. One non-mesh alternative is a pessary, a small plastic device inserted into the vagina to provide support for the drooping organs.
Frequently Asked Questions About Surgical Treatment for POP
Can a prolapse be fixed without surgery?
Often, pelvic organ prolapse is treated using less invasive non-surgical treatments like pessaries, kegel exercises, weight loss, and/or by seeing a pelvic floor physical therapist. We often recommend, and always discuss, nonsurgical treatments for relief of symptoms associated with all types of POP – vaginal vault prolapse, uterine prolapse, cystocele, rectocele, and enterocele.
When is a vaginal prolapse procedure needed?
A procedure to repair uterine prolapse (or vaginal prolapse) is rarely needed. That is, prolapse is rarely life threatening. We take great pride in recommending treatment options designed to fit your goals and needs based on your symptoms, your pelvic exam, and your medical/surgical history. Sometimes these plans include surgery and sometimes we can get you where you want to be without it.
What is the best surgery for pelvic organ prolapse repair?
There are a number of procedures that target POP because of the many organs affected and the variety of depending factors. These surgeries include:
- Colporrhaphy
- Laparoscopic or vaginal hysterectomy
- Uterine suspension
- Vaginal vault suspension
- Anterior repair
- Posterior repair
- Sacrocolpopexy
- Sacrohysteropexy
There is no single, best surgery for every patient. We specialize in all of the above procedures and can build a surgical (or non-surgical) plan to meet your needs.
Does a vaginal prolapse surgery also help incontinence?
Depending on the procedure, surgery can resolve incontinence issues caused by weakened pelvic muscles. However, in some cases there is also a risk of increased incontinence with surgery. Any discussion about prolapse repair should also include the potential for unmasking or improving incontinence as both are very common results. If you leak urine, or have leaked urine in the past, it is important to notify your doctor when discussing options for prolapse treatment or repair.
How long does it take to recover from POP surgery?
Depending on which surgery you’ve undergone, you may be able to leave the hospital the same day, or you may need to stay overnight. In rare cases where you need a larger abdominal incision (like an abdominal hysterectomy), you my need to spend a few nights in the hospital. Overall, recovery is relatively fast, and consists mainly of avoiding recurrence of prolapse by minimizing any activity that can put increased pressure on the repair, such as strenuous physical activity. This can be anywhere from a few weeks to a few months depending on the procedure.
How painful is prolapse surgery?
Surgery is performed under general, regional or local anesthetic. Pain is managed after surgery in a variety of ways, and as with any surgery, the level and duration depends on the procedure and other patient factors. In general, these surgeries are not incredibly painful. Many patients do not require opioid pain medications after leaving the hospital, but there is no way to predict how much pain a particular patient will have after the procedure.
What is the best surgery for uterine prolapse?
Uterine prolapse occurs when the support structures of the uterus and upper vagina become weak and the uterus drops into the vaginal canal. There are two general approaches to surgery for uterine prolapse: repair or removal. Repair means a surgical procedure aimed at repairing the weakened pelvic floor tissues, while removal means a hysterectomy (removal of the uterus). There is some debate among gynecologists regarding the need for hysterectomy to treat uterine prolapse though most of the current data that exists for uterovaginal prolapse was collected when hysterectomies were performed at the time of prolapse repair.
How long does a prolapse repair last?
The aim of surgical repair is a long-lasting return to normal pelvic function (so you can return to your normal activities), and most procedures have a very high success rate. However, all surgeries have risks, and among those are the possibility for recurrence. There is also always a chance that another part of the vaginal wall may prolapse after repair of another.
How do they fix uterine prolapse with surgery?
If you opt for repair rather than a hysterectomy, the procedure involves putting the uterus back into its normal position, and suspending it by reattaching the pelvic ligaments to the lower part of the uterus. Surgical repair can be done using sutures, a tissue graft, or synthetic material. If you and your surgeon decide that the best choice for you involves surgical removal of the uterus, the top (apex) of the vagina is suspended to prevent other pelvic organs from prolapsing into the same space that the uterus previously occupied.
How successful is uterine prolapse surgery?
In the majority cases, surgeries for vaginal or uterine prolapse are highly effective. There is always a chance that prolapse can recur, and this is more common with severe prolapse and compounding factors including age and weight.