The causes, symptoms and treatment for pelvic prolapse.
Pelvic prolapse is the “falling” of pelvic organs because of weakened connective tissues or muscles that hold them in place. A pelvic prolapse can occur as a result of pregnancy and childbirth, repeated physical exertion and straining, genetic factors, and/or aging.
The organs involved in a pelvic prolapse include the uterus, vagina, bladder, or rectum. The symptoms of a pelvic prolapse include urinary incontinence, difficulty with bowel movements, pressure or bulging at the opening of the vagina (particularly after prolonged standing or walking), ulceration or irritation of prolapsed tissues (usually vagina or cervix), or sexual discomfort.
Pelvic prolapse is becoming a more common women’s health issue as the population ages and women lead more active lives for many decades after menopause. Fortunately, less invasive surgery and more treatment options are available than ever before for women with a pelvic prolapse.
A conservative approach for a pelvic prolapse is the use of a pessary. Pessaries are removable devices placed into the vagina to support the uterus, bladder, and/or rectum. They are made of plastic or silicone and come in a variety of shapes and sizes. We can fit the appropriate pessary in the office.
The gold standard for surgical treatment of pelvic prolapse has been the abdominal sacrocolpopexy. In this procedure, a mesh is attached to top of the vagina or cervix from inside the abdomen and the opposite end of the mesh is attached to the hollow of the sacrum or tail bone. This elevates the tissue to bring it back into a more normal anatomic position. Fortunately, we can now do this procedure in a less invasive way through the laparoscope. For more information, see a description under da Vinci® robotic laparoscopic sacrocolpopexy.
Insertion of mesh through the vaginal can also be done to correct pelvic prolapse. Like the laparoscopic approach, such procedures are also minimally invasive. However, they do carry inherent risks, and the FDA has reported on problems associated with the use of vaginally inserted mesh material. Because prolapse surgery using vaginally inserted mesh can be performed under regional anesthesia (spinal or epidural), these procedures are often best suited for older women with medical limitations.
During an office consultation, we can discuss the various conservative options and surgical methods in detail to find the best treatment for each woman, given the type of prolapse she may have and her desired approach.