Pelvic Organ Prolapse

Pelvic organ prolapse means that the uterus and/or the vagina have fallen down from its normal position in the pelvis. This prolapse is probably caused by injuries sustaining during childbirth, aging, a woman's tissue composition, chronic coughing and heavy lifting.

Prolapse can occur in different areas of the vagina:

• Cystocele is caused by a defect in the anterior vaginal wall, which allows the bladder to protrude into the vagina. If the defect is severe enough, the bladder may protrude through the vaginal opening. Women who have a cystocele may experience pelvic pressure, involuntary loss of urine when she coughs, sneezes, or lifts something heavy, a protrusion from the vaginal opening, and an uncomfortable feeling during intercourse. Occasionally, women with cystocele may also experience involuntary urine loss immediately after she feels the urge to urinate and urinary retention (unable to empty her bladder) Frequently, the involuntary loss of urine associated with coughing, sneezing, or lifting will become less severe because the urethra is kinked when the prolapse becomes severe.
• Rectocele is caused by a defect in the back of the vagina, which allows the rectum to protrude into the vagina. If the protrusion is large enough, it can be seen or felt outside the vagina. Women who have rectocele often experience pelvic pressure, a protrusion from the vaginal opening, constipation, and an uncomfortable feeling during intercourse. This constipation frequently can be relieved by assuming a specified posture or put pressure in the back of the vagina.
• Enterocele is caused by a defect high in the back of the vagina, which allows the small intestine to protrude into the vagina. If the protrusion is severe enough, it may be seen or felt outside the vagina. Women who have enterocele often experience pelvic pressure, lower backache, a protrusion from the vaginal opening, and an uncomfortable feeling during intercourse
• Vaginal vault prolapse is caused by tears in the tissue, which attach the top of the vagina to the pelvic sidewall. When the top of the vagina falls down, it can cause the front and the back of the vagina to fall down as well. In its most severe form, the entire vagina can protrude outside the vaginal opening. This complete prolapse of the vagina is known as procidentia.
• Uterine prolapse - the uterus can fall down by itself or with prolapse from different part of the vagina. Women with uterine prolapse often experience pelvic pressure, lower backache, a protrusion from the vaginal opening, and an uncomfortable feeling during intercourse.

Evaluation for Pelvic Organ Prolapse
The initial evaluation for pelvic organ prolapse takes approximately 30-45 minutes and involves a detailed history and physical examination. Usually, no other tests are involved. If a woman also has urinary incontinence, the evaluation may take longer.

Treatment for pelvic organ prolapse
Pelvic organ prolapse is rarely caused by serious underlying medical conditions such as cancer. Consequently, the choice of treatment usually depends on the severity of symptoms and how much these symptoms are interfering with the quality of life or daily activity.

• Pessary, a small latex or plastic device that you put in the vagina to prevent the vagina and/or the uterus from falling down. It can be used to treat all types of prolapse. Pessary come in many shapes and sizes. The most commonly used pessary looks like a donut and a diaphragm. A properly fitted pessary does not cause any discomfort. Usually, a woman is not even aware that she is wearing a pessary. It does not restrict one's daily activities and can be used for many years without problems. If so desired, the pessary can be easily removed by the individual herself at bedtime and reinserted in the morning. Some women with prolapse cannot retain a pessary in the vagina for various reasons.
• Cystocele is repair through a vaginal incision. If the patient's own tissue is inadequate to perform a proper repair, a synthetic tissue may be put in to reinforce the repair. However, if a woman also has stress incontinence, the cystocele may have to be repaired through an abdominal incision or a combination of an abdominal and a vaginal incision. This surgery usually requires hospitalization for 1-2 days. After discharge, the patient should refrain from strenuous or sexual activities for six weeks in order for the repair to heal properly.
• Rectocele is repaired through a vaginal incision. If the patient's own tissue is inadequate to perform a proper repair, a synthetic tissue may be put in to reinforce the repair. This surgery usually requires an overnight hospital stay. After discharge, the patient should refrain from strenuous or sexual activities for six weeks in order for the repair to heal properly. She should also follow a high fiber diet and refrain from straining during bowel movements.
• Enterocele is repair through a vaginal or abdominal incision. This surgery usually requires hospitalization for 1-2 days. After discharge, the patient should refrain from strenuous or sexual activities for six weeks in order for the repair to heal properly.
• Vaginal vault prolapse is repair through a vaginal or an abdominal incision. The surgery may require using a piece of synthetic tissue to reattach the dropped vagina to the bony pelvis. The length of hospital stay after this procedure is usually 2-3 days. After discharge, the patient should refrain from strenuous or sexual activities for six weeks in order for the repair to heal properly.
• Uterine prolapse is usually treated by a hysterectomy. The hysterectomy is usually performed through a vaginal incision. A vaginal hysterectomy usually requires hospitalization for 1-2 days. After discharge, the patient should refrain from strenuous or sexual activities for six weeks in order for the incisions to heal properly.