Pelvic Floor Prolapse

Pelvic floor prolapse affects over 50% of women however only 33% of women become symptomatic. Prolapse is best described as a type of hernia of the vagina, but is also commonly referred to as a "dropped bladder" or a "fallen uterus". The risk of prolapse increases with age.


Pelvic organ prolapse occurs when muscles and ligaments in the pelvic floor are stretched and become too weakened to support the pelvic organs.


Incidence: More than 3 million women in the United States (34 million worldwide) experience symptoms of prolapse that interfere with their quality of life.


Common Symptoms
A bulge or lump of the vagina
Protruding vagina past the vulvar opening
Difficult or painful intercourse
Delayed or slow urinary stream
Vaginal pressure or heaviness
Urinary or fecal incontinence
Difficulty with bowel movements

In  some cases, patients may have to shift their position on the toilet to be able to evacuate adequately. In more severe cases, the patient notices an actual protrusion or bulge extending out of the vagina. This bulge may consist of the uterus, the bladder or rectal wall of the vagina.


Causes: The most common cause of pelvic floor prolapse symptoms is childbirth but other causes include aging, obesity, previous hysterectomy as well as genetics. 

Types of Prolapse

Cystocele

 A cystocele forms when the upper vaginal wall loses its support and slips downward allowing the bladder to drop. Symptoms may include difficulty with voiding or emptying the bladder as well as urinary incontinence and overactive bladder symptoms.

Rectocele

A rectocele forms when the lower vaginal wall loses its support allowing the rectum to bulge downward. Symptoms may include difficulty emptying bowels including the need to strain more forcefully or rectal pressure. Fecal incontinence may also occur.

Enterocele

 An enterocele forms when the weakened area is at the top of the vagina and may be more difficult to identify. Enteroceles tend to occur alongside vaginal vault or uterine prolapse.

Apical prolapse

This category includes uterine prolapse as well as vaginal vault prolapse (which occurs in patients who have previously had a hysterectomy). The weakened area causing prolapse in these patients occurs at the very top of the vagina.

Treatment Options

Nonsurgical

  • Neuromuscular rehabilitation

    This includes pelvic floor PT as well as Kegel exercises. Kegel exercises have been shown to be associated with 50 to 70% improvement in patients with some prolapse symptoms and incontinence symptoms. Unfortunately, some patients have had childbirth related nerve injuries that limit the effectiveness of these exercises and must undergo pelvic floor physical therapy which can provide other options to improve conservative management success.

  • Pessary

    Resemble diaphragms, and have a role in the management of prolapse symptoms. Other options include vaginal cones which can be used at home to improve pelvic floor strength nonsurgically.

Surgical Management*

  • Uterine Conservation

    Refers to sparing the uterus as some patients do not necessarily need to have a hysterectomy performed to adequately treat their prolapse symptoms.

  • Vaginal Prolapse Repair

    Our professional societies still regard the vaginal hysterectomy as the safest method to perform a hysterectomy. This surgical approach to prolapse is a minimally-invasive procedure that addresses many of the prolapse defects adequately without large incisions made on the abdomen. Many of these procedures are performed outpatient or only overnight hospital stays.

  • Robotic Surgery

     Robotic surgery options have also improved patient outcomes and resulted in quicker recovery compared to the previous alternatives. Robotic sacrocolpopexy or hysterectomy may be suggestive procedures to address prolapse related symptoms.

  • Abdominal Surgery

    What used to be the most common option for surgical management is less often performed but may still be a necessary primary treatment option for some patients.

*Surgical management is individualized and not the same for every patient.

For more information about sacral neuromodulation click here

For more information about prolapse  click here

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