Pelvic Organ Prolapse
Almost one in every four women in the United States have some sort of pelvic floor disorder such as urinary or incontinence or pelvic organ prolapse, and more women are likely to be affected as the population ages. The Arthur Smith Institute for Urology’s Center for Pelvic Health and Reconstructive Surgery is a state-of-the-art, specialized center offering a multidisciplinary team approach for women with urological conditions. The new center provides individualized treatment with the latest procedures targeted at comprehensive evaluation and management of disorders from urinary incontinence to pelvic organ prolapse, in addition to offering complex pelvic reconstruction by open, vaginal, laparoscopic, and robotic–assisted routes.
What is Pelvic Organ Prolapse?
Pelvic organ prolapse is a very common condition in the United States, affecting roughly half of women who have had children by vaginal delivery. It occurs when one or more of the organs in the pelvis (bladder, uterus, rectum, small or large bowel) drops down due to a weakened or stretched pelvic floor muscle and/or loss of vaginal support. This downward descent that causes prolapse may result in protrusion of the vagina, uterus, or both. In addition to vaginal childbirth, prolapse development can be attributed to Several factors, including advancing age and obesity, may lead to the development of prolapse. Hysterectomy, chronic straining, and abnormalities of connective tissue or connective-tissue repair can predispose some women to disruption, stretching or dysfunction of the structural attachments of the vagina, which in turn results in prolapse.
What are Symptoms of Pelvic Organ Prolapse?
Depending on which organs are involved in the prolapse, different symptoms may occur.
Below is a list of some common symptoms:
• Needing to change position to start or complete voiding
• Urgency to defecate
• Straining during defecation
• Incontinence of flatus, or liquid or solid stool
• Sensation of or seeing a bulge or protrusion in the vagina
• A sense of pressure or heaviness in the vagina
• Painful sexual intercourse (dyspareunia)
• Weak or prolonged urinary stream
• Feeling of incomplete emptying
• Urinary incontinence, frequency and/or urgency
Pelvic Organ Prolapse Treatments
Reconstructive Surgery
Reconstructive surgery for prolapse aims to correct the prolapsed vagina while maintaining (or improving) vaginal sexual function and relieving any associated pelvic symptoms. For those patients who do require surgery, our fellwoship-trained physicians offer laparoscopic and robotic-assisted techniques which have been shown to have quick recovery times. Some surgeries for prolapse can be performed purely vaginally, leaving no scars. An alternative to reconstructive surgery is obliterative surgery (colpocleisis), which seals off the vaginal canal either partially or totally. This procedure is typically reserved for women who are elderly, medically compromised, and no longer sexually active.
Vaginal Mesh
The use of vaginal mesh is the latest development in treatment for pelvic organ prolapse. The Arthur Smith Institute staff use this method cautiously, as it remains under study to determine whether it is a safe and effective option. For women who have more than one organ prolapse at a time, severe pelvic organ prolapse, or a previously unsuccessful prolapse surgery, the surgeon may use mesh to repair a bladder prolapse into the vagina (cystocele), rectal vaginal prolapse (rectocele), and intestinal vaginal prolapse (enterocele). These different compartment prolapses may be managed all in one procedure. The goal of these mesh procedures are designed to restore normal vaginal anatomy, while providing strong and lasting support of the pelvic organs.
