Pelvic Organ Prolapse

Pelvic organ prolapse is a condition that only affects women. It happens when tissues that support the organs in the pelvis relax. These tissues are sometimes called the "pelvic floor." When they relax too much, the organs drop down and press against or bulge into the vagina. If the bladder bulges into the vagina, doctors call this problem "cystocele." If the rectum bulges into the vagina, they call it "rectocele." Uterine prolapse means the uterus has bulged into the vagina. Some things can increase a woman's risk of having pelvic organ prolapse. They include pregnancy, past hysterectomy (surgery to remove the uterus), obesity, and older age.

Symptoms:

Many women with this problem have no symptoms. But some women with pelvic organ prolapse have symptoms that include:

Fullness or pressure in the pelvis or vagina
A bulge in the vagina or coming out of the vagina
Urinary incontinence, urgency, frequency, the sensation of incomplete emptying.
When they use the toilet, some women need to press on the bulge in the vagina with a finger to get out all their urine or to finish a bowel movement. This maneuver is called splinting.

Diagnosis:

Pelvic exam, may be done with standing or squatting to appreciate bulge.

Treatment:

Women who have no symptoms or who are not bothered by their symptoms do not need treatment. For women with symptoms that bother them, doctors suggest different treatments, including:

Pelvic floor muscle exercises – Patients work with a physical therapist for 8 to 12 weeks to strengthen the pelvic muscles.
A vaginal pessary – This device fits inside a woman's vagina to support the bladder and push it back into place. Pessaries come in different shapes and sizes.
Surgery – A surgeon can move dropped organs back where they belong and strengthen the tissues that keep them in place. Women should have this type of surgery only if they are done having children.
- Cystocele repair with or without biologic graft (Anterior repair)
- Rectocele repair (Posterior repair)
- Robotic Sacrocolpopexy – vaginal vault suspension
- Colpocliesis – surgical closure of vaginal canal