Pelvic Organ Prolapse

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Understanding the condition is the first step towards relief.

Do you have pelvic pressure or a bulge coming from your vagina? Prolapse can involve the vaginal wall overlying the bladder or the rectum and the uterus can prolapse (or come down) as well. Even if you have had a hysterectomy (your uterus has been removed) you can still have prolapse at the top of the vagina or vaginal walls.

Pelvic organ prolapse is incredibly common and effective treatment is available. If your prolapse symptoms keep you from feeling comfortable during everyday activities, come see Dr. South about treatment options.

Why does pelvic organ prolapse happen?

Pelvic organ prolapse happens when the muscles and tissues supporting the pelvic organs (the uterus, bladder, or rectum) become weak or loose. As the muscles and tissues weaken, the pelvic organs drop or press into or out of the vagina.  Most of the time, pelvic organ prolapse is the result of carrying—and vaginally delivering children, which weakens the pelvic floor.

There are 3 types of prolapse and it depends on which organ is affected:

  • Cystocele is when the bladder protrudes into the vagina, creating a bulge. It’s the most common form of prolapse.
  • Rectocele is when the rectum bulges into the back wall of the vagina.
  • Uterine prolapse involves the uterus dropping into the vagina.
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What are the symptoms?

In addition to the sensation of feeling an uncomfortable bulge in the vagina, you can experience symptoms such as:

  • Pain or pressure in the pelvis, the lower back, or both
  • Urinary problems, like urine leaking or urinary frequency
  • Constipation

As prolapse worsens, you may notice:

  • A bulging, pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements
  • The feeling of “sitting on a ball”
  • Needing to push stool out of the rectum by placing fingers into or around the vagina during a bowel movement
  • Difficulty starting to urinate or a weak or spraying stream of urine
  • The sensation that you are unable to empty the bladder well
  • The need to lift up the bulging vagina or uterus to start urination
  • Urinary leakage with intercourse
  • Though unusual, severe prolapse can block the flow of urine and cause recurrent urinary tract infections or even kidney damage

What are the treatment options?

  • Pessary – A silicone device (much like a diaphragm) used to treat pelvic prolapse.  The device can improve voiding, urgency, and incontinence for women with urinary incontinence and pelvic organ prolapse, no matter the stage.
  • Vaginal Hysterectomy with support procedures- This is a surgical procedure to remove the uterus through the vagina. During a vaginal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian tubes, and upper vagina, as well as from the blood vessels and connective tissue that support it, before removing the uterus.  There is no abdominal incision.  Then support sutures are placed to hold up the walls of the vagina using the woman’s own native tissues.
  • Colpocleisis- This is a surgical procedure where the length of the vaginal canal is shortened. It is used to treat vaginal or uterine prolapse.  This is for women who are no longer sexually active.  In addition, this options is an excellent choice for women with complex medical problems or who are advanced in age.
  • Sacrocolpopexy– This is a surgical procedure where a surgical mesh is attached from the vagina to the sacrum (tail bone). If a patient still has her uterus, the surgeon may decide to remove it, with or without leaving the cervix in place. If the cervix is left in place, the mesh will be applied over the top of the cervix, as well as to the vaginal walls.

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