Pelvic Prolapse

Written by: Dr. Jason Hurt

Pelvic prolapse is a condition that occurs when muscles and ligaments that support your pelvic organs weaken. As a result, these organs (uterus, vagina, cervix, bladder, urethra, or rectum) slip from their normal position.

Severe uterine prolapse can cause the uterus to slip (prolapse) partially into the vagina. It may cause the upper part of the vagina to sag into the vaginal canal or even outside the vagina.

Some women with prolapse have no symptoms. Others may experience: a feeling of sitting on a ball, pulling in the pelvis, pelvic or abdominal pain, painful intercourse, tissue from the vagina sticking out, bladder infections, vaginal bleeding, unusual discharge, constipation or frequent urination.

Pelvic prolapse is common, affecting about one in every three women who have had a child.  One in nine women have symptoms that are severe enough to need surgery.  Risk factors for prolapse include multiple vaginal deliveries, age, obesity, hysterectomy, and smoking.

Surgical treatment for this condition is called sacrocolpopexy. During the operation, surgical mesh is used to hold your affected pelvic organ(s) in their natural position. The mesh remains in place permanently. This procedure is not the same as what occurs during transvaginal placement of mesh. Your doctor can fully explain the differences and process to you.

Sacrocolpopexy is viewed as the best way to correct pelvic prolapse and resolve symptoms.  The surgery may also be done following a hysterectomy to provide long-term support for the vagina.

Open Surgery: Sacrocolpopexy is often done using open surgery. A long, horizontal incision (cut) is made in the lower abdomen. The incision must be large enough for your surgeon to fit his or her hands inside your body to reach your organs.

A Minimally Invasive Surgical Option With Robotic Assisted Laparoscopic Sacrocolpopexy – a few small incisions are made similar to traditional laparoscopy to perform the operation minimally invasive.

The da Vinci Robotic Surgical System features a magnified 3D HD vision and tiny wristed instruments that bend and rotate far greater than the human hand. These features enable these surgeries to be performed with enhanced vision, precision, and control – even for complex cases.

Sacrocolpopexy offers the following potential benefits compared to open surgery:

  • Lower rate of complications
  • Shorter hospital stay
  • Less blood loss
  • Less chance of a post-operative fever

Robotic Sacrocolpopexy offers the following potential benefits compared to traditional laparoscopy:

  • Less blood loss
  • Less postoperative pain
  • Faster recovery from surgery

Pelvic Organ Prolapse – Treatment Overview

Pelvic Organ Prolapse

Many women who have pelvic organ prolapse do not have symptoms and do not require treatment. If your symptoms are bothersome, you may want to consider treatment. Treatment decisions should take into account which organs are affected, how bad symptoms are, and whether other medical conditions are present. Other important factors are your age and sexual activity.

Many women are able to reduce pain and pressure from a pelvic organ prolapse with nonsurgical treatment, which may include making lifestyle changes, doing exercises, and/or using a removable device called a pessary that is placed into the vagina to support areas of prolapse.

If your pelvic organ prolapse is causing pain or problems with bowel and bladder functions or is interfering with your sexual activity, you may want to consider surgery. Surgical procedures used to correct different types of pelvic organ prolapse include repair of the supporting tissue of the prolapsed organ or vaginal wall. Another option is the removal of the uterus (hysterectomy) when it is the prolapsed organ or if it is causing the prolapse of other organs (such as the vagina).

Ongoing treatment

Pelvic organ prolapse can be a long-lasting condition. But it often responds to adjustments in activities and lifestyle habits. If you have tried self-care, such as eating high-fiber foods, staying at a healthy weight, and doing pelvic floor (Kegel) exercises, but your symptoms are increasingly bothersome, you may want to consider nonsurgical treatment. Treatment will be different depending on which organs are involved, how bad your symptoms are, and what other medical conditions are present. Treatment may include using a pessary, a removable device that is placed into the vagina to support areas of pelvic organ prolapse.=

Treatment if the condition gets worse

If you have pain and discomfort from pelvic organ prolapse that does not respond to nonsurgical treatment and lifestyle changes, you may want to consider surgery. The choice of surgery depends upon which organs are involved, how bad your symptoms are, and what other medical conditions are present. Also, your surgeon may have experience with and preference for a certain procedure. Types of surgery for pelvic organ prolapse include: (cystocele) or urethra (urethrocele) repair, removal of the uterus (hysterectomy), repair of the rectum (rectocele repair), repair of the vaginal wall (vaginal vault suspension), or closure of the vagina (vaginal obliteration).