Pelvic Organ Prolapse

Pelvic Organ Prolapse is when one or more parts of the vagina and pelvic organs are bulging to the opening of the vagina or beyond.

A cystocele is when the anterior vaginal wall is prolapsing with the bladder behind it.  The uterus itself can prolapse.

An enterocele is when the apex or top of the vagina is coming down, either behind the cervix in patients that still have a uterus, or just the vagina with intestines behind it in patients that have had a hysterectomy (vaginal vault prolapse).

A rectocele is a bulging of the posterior vaginal wall with the rectum behind it.

Many patients will have more than one part of the vagina bulging and can have a combination of multiple defects. Patients with prolapse may have a variety of symptoms, ranging from just bulging, pressure, and low back pain to increased urinary frequency and urgency, urinary incontinence, voiding difficulty, repeated urinary tract infections and difficulty with bowel evacuation.

A normal vagina is supported by the levator muscles of the pelvic floor and the endopelvic fascia, which is an intricate natural elastic layer of connective tissue lining the entire pelvic floor. Pelvic organs (bladder, uterine cervix, rectum and vagina) are partially embedded into the endopelvic fascia. Weakening or breaks of the fascia result in the different types of prolapse.  Possible risk factors for pelvic organ prolapse include genetic factors, number of full term pregnancies (particularly vaginal birth), menopause, advancing age, prior pelvic surgery, connective tissue disorders, and factors associated with elevated intra-abdominal pressure such as obesity and chronic constipation with excessive straining.

 

pelvic anatomy cystocele
rectocele enterocele

Figures: A- normal vaginal support, B- cystocele, C-rectocele, D- enterocele/post hysterectomy vaginal vault prolapse

There is really no correlation between the amount of prolapse and patient symptoms.  Usually the treatment for prolapse is surgery, but there are devices called pessaries that can be used to hold the prolapse up in the vagina and relieve symptoms for patients who are unable to have surgery.  Keep in mind, that surgical repair can often be done through the vagina with no abdominal incisions or through minimally invasive laparoscopic surgery, including the da Vinci Robotic surgery. Often combinations of robotic/laparoscopic and vaginal repairs are needed for complex or advanced prolapse.  A pubovaginal sling is also often done with other prolapse repairs if needed to treat urinary incontinence. Whatever you problem, we will thoroughly evaluate all your symptoms and tailor your surgical repair to your particular needs.

Minimally Invasive Prolapse Surgeries Include:

 

Call Peachtree Gynecology today at 678-539-5980 to make an appointment today.