Vaginal and Pelvic Prolapse
Pelvic organ prolapse is a condition in which structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself may begin to prolapse, or fall, out of their normal positions. Without medical treatment or surgery, these structures may eventually fall farther into the vagina or even through the vaginal opening if their supports weaken enough.
The symptoms that result from pelvic organ prolapse commonly affect sexual functions and bodily functions such as urination and defecation. Pelvic pressure and discomfort are also common symptoms.
Your treatment will depend on the severity of your symptoms. If your prolapse does not bother you, your health care provider might recommend treating your prolapse without surgery. If symptoms get worse and significantly affect your quality of life, surgery might be needed.
Weakness of the pelvic floor often affects more than one area. For example, if you develop symptoms of one type of prolapse, you’re more likely to develop other types. Mayo Clinic pelvic floor specialists try to correct all prolapse-related problems at one time.
Physical therapy might be recommended, with pelvic floor exercises using biofeedback to strengthen specific muscles of the pelvic floor. Biofeedback involves the use of monitoring devices with sensors that are placed in your vagina, rectum or on your skin.
As you perform an exercise, a computer screen shows whether you’re using the right muscles and the strength of each squeeze (contraction) so you learn how to do the exercises properly. Long-term strengthening of these muscles is the most important factor in reducing your symptoms. Biofeedback teaches you how to use your own muscles to keep them strong.
Some women might prefer a nonsurgical option for prolapsed organs. Pessaries are silicone devices that come in a variety of shapes and sizes. They’re placed vaginally to hold the pelvic organs in place.
Talk to your surgeon about why one procedure might be better for you than another, what the surgical approach will be and what materials will be used. Also ask your surgeon about the long-term success for your planned procedure.
Depending on the location of your prolapse, there are different surgical strategies for various types of prolapse:
- Posteriorprolapse. A posterior prolapse often involves the rectum and is called a rectocele. Your surgeon secures the connective tissue between your vagina and rectum to reduce the size of the bulge. Your surgeon also removes excess tissue.
- Anterior prolapse. An anterior prolapse often involves the bladder and is called a cystocele. Your surgeon pushes your bladder up and secures the connective tissue between your bladder and vagina to keep the bladder in its proper position. The surgeon also removes excess tissue. If you have urinary incontinence, your doctor might recommend a bladder neck suspension or sling to support your urethra.
- Uterine prolapse. If you don’t plan to have more children, your surgeon might recommend surgery to remove the uterus (hysterectomy) to correct uterine prolapse.
- Vaginal vault prolapse. In women who have had a hysterectomy, the prolapse is at the apex, or an apical prolapse. Also known as a vaginal vault prolapse, this type of prolapse might involve the bladder, rectum and, commonly, the small bowel, where the bulge is called an enterocele. Your surgeon might perform corrective surgery through the vagina or abdomen. In a vaginal approach, your surgeon will use the ligaments that support the uterus to correct the problem. In an abdominal approach — which might be performed laparoscopically, robotically or as an open procedure — your surgeon attaches the vagina to the tailbone, and small portions of synthetic mesh might be used to help support vaginal tissues. This particular type of surgery is called sacrospinous fixation. Other vaginal vault suspensions might also be recommended. Talk to your doctor about the use of mesh materials if you have concerns.
Remember that prolapse surgery only repairs the tissue bulge. If the bulge doesn’t bother you, surgery isn’t needed. Recurrent prolapse is common, as surgery does not repair the underlying weakened tissues.
Doctor Ahdoot is an experienced, caring physician who will partner with you through every phase of your life. He is professional and compassionate, and will take the time to discuss your condition and the best possible treatment for your individual needs.