Pelvic Organ Prolapse

What is Utero-Vaginal Prolapse?

A prolapse is a medical condition where an organ or tissue moves or is displaced from its normal position. A pelvic organ prolapse is a condition that occurs when the structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself slide out from their normal position. Utero-vaginal prolapse is a downward movement of the uterus and/or vagina.

Vaginal Prolapse/Pelvic Floor Disorders

Vaginal prolapse is a condition where the pelvic organs such as bladder, rectum, uterus, urethra, and small bowel protrude into the vaginal wall. Several types of vaginal prolapse conditions have been identified and they include:

Cystocele – Bladder protrudes into the vagina
Rectocele – Rectum protrudes into the vagina
Vaginal vault prolapse – Top portion of vagina herniates into the vaginal canal post hysterectomy
Uterine prolapse – Uterus prolapses into the vagina
Enterocele – Small bowel herniates into the vagina

Causes of Vaginal Prolapse

The main cause of vaginal prolapse is the weak pelvic floor muscles, tissues, and ligaments that support the vagina and surrounding tissues and organs.

The factors that can cause vaginal prolapse include

frequent lifting of heavy objects,
chronic cough,
severe constipation,
menopause,
childbirth,
previous surgeries in the pelvic area,
advanced age,
hysterectomy and
obesity.

Symptoms of Vaginal Prolapse

Women with prolapse may have different symptoms based on the type of prolapse. The signs and symptoms include:

urinary frequency, urgency and/or incontinence
difficulty emptying bowels
enlarged and wide vaginal opening,
vaginal lump
the protrusion of tissues at the front and back wall of the vagina.
It is also important to know lots of women have degrees of prolapse. Having prolapse doesn’t necessarily mean that treatment or surgery is required!

Conservative treatments for Pelvic Floor Disorders

If the symptoms are mild, non-surgical treatment options such as:

medications,
pelvic floor exercises,
vaginal pessaries (a device that is inserted in the vagina to support the pelvic floor), and
lifestyle changes may be helpful
addressing issues such as chronic cough or chronic constipation

Surgical treatment

Surgery can be considered in patients with severe symptoms of pelvic organ prolapse. There are different types of procedures to address a specific prolapse. The aim of pelvic floor reconstruction is to restore normal anatomy and function of the pelvic organs. Surgery can be done through an open incision in the vagina, the most essential part of the surgery is to restore support to the vaginal apex ( top of the vaginal skin).

Vaginal Prolapse surgery

Native tissue surgery

Pelvic organ prolapse was traditionally treated surgically using native vaginal tissue (NT). It involved the use of the patient’s own tissue and sutures to restore the vagina to a natural position by re-attaching it to the various support structures.

Reports in the literature of high recurrence rates associated with vaginal native tissue repair led to the development of alternative techniques, such as synthetic mesh. These procedures are performed on a small amount of selected patients as mesh surgery is associated with higher complication rates.

At POGS we do not perform the MESH surgery. If we think you might be a rare candidate for this surgery we may refer you to a subspecialist for second opinion and further management.

Anterior Repair / Posterior Repair

Colporrhaphy (Repair) is the surgical procedure to correct cystocele and rectocele. In this procedure skin is incised and bladder and/or rectum are reattached to their normal positions, excess tissue is removed and the incisions are closed.

Uterine prolapse treatment

Uterine prolapse can be treated by a procedure called hysterectomy, where the uterus is removed. After the hysterectomy the top (apex/vault) of the vagina may need to be attached to the utero-sacral ligament to prevent future Apex/vault prolapse.

Vaginal vault suspension

The top of the vagina is attached to a strong ligament at the back of the pelvis or at the base of the spine to support the vagina. The ligaments and muscles are reattached to the top of the vagina with the help of sutures. Suturing the vaginal walls will only repair the defect and will not provide support to the apex of the vagina and to the supporting structures.

The most common procedures to restore vaginal apex support is:

Sacrospinous Ligament Fixation – This is performed through a vaginal approach. The vaginal apex is suspended to a patient’s sacrospinous ligaments. Mesh material is not used.

Some surgeons use abdominal or laparoscopic approaches to this procedure. There are many different ways of treating the prolapse surgically. This depends on the prolapse itself and surgeon’s preference.