Causes and Symptoms
Symptoms of Pelvic Organ Prolapse may include: pelvic pressure or pain, urinary symptoms, recurrent pain with intercourse, a visible bulge in the vaginal area that often worsens with lifting or straining, constipation, and having to push down on the vagina to move your bowels. Urinary symptoms may include: frequent urination, sudden urges to go, loss of urine control, and recurrent urinary tract infections.
Several things can “drop” within the vagina and they all have different possible symptoms and treatments. A cystocele (pronounced cysto-seal) is a loss of bladder support allowing the bladder to push into the vaginal canal. A rectocele (pronounced recto-seal) is when the rectum bulges into the lower part of the vagina. A prolapsed uterus refers to the loss of ligament support to the uterus and leads to the uterus dropping into the vaginal canal. Apical prolapse refers protrusion of the “cuff” at the top of the vagina. This “cuff” is present after having a hysterectomy. Finally, an enterocele (pronounced entero-seal) refers to small intestine protruding around the “cuff.”
A detailed history and examination is the first step in evaluation of all forms of POP. Your doctor may ask you to keep a brief diary of any urinary symptoms and adjunctive testing may be indicated. A cystoscopy is a look inside the bladder. This is an excellent way to determine the extent of the problem because the prolapse can be visualized with both an empty and full bladder. The procedure is done in the office and only takes a few minutes. Some numbing jelly is placed on the urethra. An urodynamics assesses the function of your bladder. This is important to do prior to intervening on POP to see what effects lifting the bladder into place may have on urination. It is a test done in the office and takes about an hour to complete. On rare occasions an MRI of the pelvis may be ordered to image the pelvic organs and their movement.
At Alpine Urology, we care about you and your urological needs. We encourage you to make an appointment to discuss your treatment options.
Treatment for POP can be both non surgical and surgical.
Non-surgical management includes placing a soft rubber ring called a pessary into the vaginal canal. The ring can hold the pelvic organs into place. It has to be removed and cleaned intermittently. Side effects can include pelvic discomfort, bleeding, vaginal irritation, pain with intercourse, and vaginal discharge.
Surgical approaches can be performed vaginally or through the abdomen. The choice of approach depends largely on the type and degree of prolapse as well as patient preference. Vaginal approaches are commonly used for cystoceles and rectoceles while the abdominal approach is used for apical prolapse and some cystoceles.
In the vaginal approach an incision is made in the vagina and the bladder or rectum are separated from the vaginal tissue. At this point, the muscles can be brought together with stitches or a piece of material can be placed to support the bladder or rectum. This material can be biologic (made from an animal) or synthetic (mesh). Mesh is rarely used today due to concerns about complications. The biological material has better long term success rates than the stitches alone and it dissolves over time so it has less risk than the mesh which never dissolves.
The abdominal approach is typically done using the Da Vinci robotic surgical system. A small opening is made above the belly button and the belly is inflated with gas. A few fingertip sized openings are made in the lower abdomen. The vaginal cuff is exposed and a piece of synthetic material is attached using sutures. The cuff is pulled back and stitched to a bony area called the sacrum. It is important to understand that the synthetic material used is different than the vaginal mesh that has received so much media attention.
Either type of surgery typically necessitates an overnight stay in the hospital. Patients should not lift more than 10 pounds for 6 weeks after the surgery. Risks of either surgery may include: pain, bleeding, infection, recurrence or persistence of symptoms, injury to adjacent organs or tissue, anesthetic complications, and post operative complications like blood clots and pneumonia. These complications are rare and will be discussed in great detail prior to any surgical intervention.
Pelvic Organ Prolapse is very common affecting thousands of women each year. While not all POP requires intervention it is good to know that patients have options for treatment.
OUR PHYSICIANS ARE CERTIFIED THROUGH THE AMERICAN BOARD OF UROLOGY.