Feature Summary

 The following problems are associated with pelvic organ prolapse:

• A feeling of pressure, heaviness, or bulging in the vagina that worsens at the end of the day or during bowel movements.
• The sensation of "sitting on a ball".
• The need to push stool out of the rectum by inserting fingers into or around the vagina during a bowel movement.
• Difficulty starting to urinate or having a weak or spraying stream of urine.
• Urinary frequency or the sensation of not being able to empty the bladder fully.
• Lower back discomfort.
• The need to lift the bulging vagina or uterus to start urination.
• Urinary leakage during intercourse.
• In severe cases, prolapse can block urine flow, leading to recurrent urinary tract infections or kidney damage.

Overview

Pelvic organ prolapse is the dropping or prolapse of any pelvic floor organs, such as the bladder, uterus, vagina, small bowel, or rectum. It can also be referred to as:

• Cystocele: Prolapse of the bladder into the vagina, the most common condition.
• Urethrocele: Prolapse of the urethra (the tube that carries urine).
• Uterine prolapse.
• Vaginal vault prolapse: Prolapse of the vagina.
• Enterocele: Small bowel prolapse.
• Rectocele: Rectal prolapse.

Features

There are two types of prolapse surgery: obliterative and reconstructive.

• Obliterative surgery: Closes off part or all of the vagina. This may be suitable for elderly patients with multiple chronic conditions who cannot tolerate a more extensive procedure. The benefits of this surgery include a short operative time, minimally invasive surgery without an abdominal wound, a short hospital stay, and a quick recovery. However, the patient will no longer be able to have sex after this surgery.
• Reconstructive surgery: Aimed at repairing the pelvic floor and returning organs to their original position. There are several reconstructive surgeries, including:
• Sacrospinous fixation and uterosacral ligament suspension.
• Anterior and posterior colporrhaphy.
• Sacrocolpopexy, sacrohysteropexy, and pectopexy.

Procedure

Obliterative Surgery: Closes off part or all of the vagina.

Reconstructive Surgery:

• Sacrospinous Fixation and Uterosacral Ligament Suspension: Your own tissues, sacrospinous ligaments, or uterosacral ligaments, are used to fix or suspend the sagging pelvic organs. Your surgeon will make an incision in the vagina and use stitches to attach the vaginal vault to a ligament in the pelvis. The stitches may be permanent or dissolve over time.
•  Anterior and Posterior Colporrhaphy: The goal is to strengthen the tissue that supports the pelvic organs. An anterior repair is used when the bladder drops and presses against the front of the vagina. Posterior repair is used when the rectum drops and pushes into the back of the vagina. This procedure is also done through the vagina using your own tissues.
• Sacrocolpopexy, Sacrohysteropexy, and Pectopexy: These procedures use surgical mesh to support organs that have dropped down. Sacrocolpopexy and pectopexy repair the prolapse of the vaginal vault or cervix. Sacrohysteropexy is used to fix the prolapse of the uterus. These operations may be completed using a laparoscopic or robotic-assisted approach after evaluation by the doctors.

Notification

Risks and Complications:

• Pain during sex

• Pelvic pain

• Urinary incontinence

• Wound infection

• Mesh erosion in the vagina or abdomen when a mesh is used for repair.