Pelvic Organ Prolapse

Pelvic Organ Prolapse

Prolapse is a fairly common condition, with one third of all women experiencing prolapse or another pelvic floor disorder their lifetime. Mild cases of prolapse can often be managed with simple treatment, but more severe cases may involve surgery to resolve. After women have given birth or as they get older, it may be common to experience issues with bladder control, dropped pelvic organs or to struggle with bowel movements, but for many women, these symptoms don't have to merely be managed and lived with. There are treatment option available, and our specially trained gynecologists at NGPG can help diagnose and create a plan with you. 

What is pelvic organ prolapse?

In women, the pelvic organ prolapse is used to describe abnormal support of pelvic organs. These organs include the bladder and urethra, uterus and cervix, vagina, and rectum. In pelvic organ prolapse, the muscles and connective tissues of the pelvis can no longer support these organs, and they can drop. Unless there are problems emptying your bladder or bowels, this is not a dangerous condition.

What are the types of pelvic organ prolapse?

There are several types of pelvic organ prolapse:

  • Cystocele
    Prolapse of the vagina supporting the bladder
  • Enterocele
    Prolapse of the vagina involving the small intestines
  • Rectocele
    Prolapse of the vagina involving the rectum
  • Uterine prolapse
    Prolapse of the uterus and the top of the vagina
  • Vaginal vault prolapse
    Prolapse of the top of the vagina

What are the symptoms of pelvic organ prolapse?

The symptoms of pelvic organ prolapse can start gradually. If the prolapse is mild, it may only be discovered during a pelvic exam. Some women may not notice any problems until the prolapse pushes through the opening of the vagina.

Common symptoms can include:

  • A feeling of pressure or a bulge in the vagina
  • Pelvic organs pushing out of the vagina
  • Bladder problems
    This includes difficulty completely emptying your bladder or leakage of urine. 
  • Problems with a bowel movement

What are the risk factors for pelvic organ prolapse?

Things that can weaken the muscles of the pelvic floor, such as pregnancy, childbirth, and connective tissue disorders, can predispose women to pelvic organ prolapse.

  • Pregnancy and vaginal childbirth
    You may be at high risk if you required the use of forceps to help deliver your baby
  • Menopause and aging
  • Repeated heavy lifting
  • Obesity
  • Chronic constipation and straining​
  • Chronic cough

Diagnosing & treating pelvic organ prolapse

How is pelvic organ prolapse diagnosed?

Your healthcare provider will discuss your medical history and perform a pelvic exam. You may be asked to bear down or cough to see if you leak urine. You may be checked to see if you are able to completely empty your bladder. A rectal exam may be performed. 

Does pelvic organ prolapse require treatment?

Many women with pelvic organ prolapse do not have symptoms or only have mild symptoms and do not require treatment.

If your symptoms become more severe, your health care provider will discuss non-surgical treatments such as:

  • Lifestyle changes
    Weight loss and diet changes can help relieve symptoms in women who are overweight or obese. Limiting drinks with caffeine or alcohol may help with bladder symptoms. Increasing water intake and dietary fiber can help with chronic constipation.  
  • Pelvic floor exercises
    Also known as Kegel exercises, pelvic floor exercises can strengthen the pelvic muscles and may slow the progression of prolapse. Your healthcare provider will help explain how to do these exercises. They may also refer you to a pelvic health physical therapist.
  • Pessary
    This is a device that is inserted into the vagina. This can immediately help with your symptoms. Your healthcare provider will discuss whether you should clean the pessary at home or have regular cleaning done in the office. Women with a pessary need regular exams to ensure that the vagina remains healthy. 

Does pelvic organ prolapse require surgery?

If lifestyle changes or a pessary do not help with your symptoms, you may require surgery. Surgery can be done to support the pelvic floor muscles and can leave the vagina in place or close off the vagina. There is a risk that your symptoms will return after surgery. The risk is higher if you have a suspension surgery than if you have an operation that closes off the vagina. Your doctor will discuss these options with you.

There are several types of surgery to provide support to the pelvic organs:

  • Uterosacral ligament suspension
    This procedure is typically done after a complete hysterectomy. It reattaches the top of the vagina to the uterosacral ligaments. This can be done vaginally or with minimally invasive laparoscopic surgery. 
  • Sacrospinous ligament suspension
    This procedure is typically done after a complete hysterectomy. It reattaches the top of the vagina to fibrous connective tissue in the bony pelvis. 
  • Sacro-colpopexy
    This procedure is typically done after removal of the uterus, but not the cervix. It involves placing a piece of mesh along the cervix or vagina and attaching to the bottom part of the connective tissue of the spine. 
  • Colpocliesis
    This procedure involves closing off the vagina. The risk of recurrent prolapse symptoms is minimal after this surgery. However, since it closes off the vagina, it is not possible to have sex after this procedure. 

Why choose NGPG Gynecologic Surgery?

NGPG is home to experienced providers you can trust. With four convenient locations across northeast Georgia, NGPG provides easy access and scheduling. Our approach to gynecologic services always centers care on the patient and family.

If surgery is necessary, we perfom our surgeries with state-of-the-art technology at Northeast Georgia Medical Center, providing our patients access to minimally-invasive laproscopic and robotic surgery options. By offering these options, we can minimize your stay in the hospital, shorten recovery times and reduce pain from surgery. NGMC Gainesville is the first hospital in Georgia to have received accreditation from the SRC as a Center of Excellence in minimally invasive gynecology. 

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