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Center for Women's Health of Lansdale Center for Women's Health of Lansdale Center for Women's Health of Lansdale Center for Women's Health of Lansdale

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PELVIC RECONSTRUCTIVE SURGERY

What is Vaginal Prolapse?

It's more common than you may think.

Vaginal prolapse (also called pelvic organ prolapse, or vaginal organ prolapse) is what happens when organs inside the pelvis fall, bulge or protrude into the vaginal wall. This condition is due to weakened muscles or ligaments that can occur from a number of causes, including childbirth, previous surgeries, and obesity. If you have signs and symptoms of vaginal prolapse, learning more about this condition (and discovering you have options!) can lead to a better way of life.

Understanding vaginal prolapse

There are a number of muscles, ligaments, and other tissues that elevate and support the pelvic area. They provide support for pelvic organs including the uterus, urethra, bladder, and the rectum.

Vaginal prolapse happens when pelvic organs, including the bladder or rectum, bulge into the vaginal wall due to a weakening of important muscles and supporting ligaments. If left untreated, these organs may fall or protrude to a point that they prolapse (bulge or push into)-the vaginal area. In extreme cases, the vagina can even fall to the point where it extends outside the body.

Healthy pelvic area before prolapse

Description: Healthy pelvic area before prolapse

The bladder, vagina, and rectum are normally well supported by pelvic muscles and ligaments

Vaginal Prolapse (VP)

Description: Vaginal Prolapse (VP)

Vaginal prolapse occurs when weakened muscles or ligaments allow the pelvic organs to descend into the vaginal wall, causing discomfort and other symptoms.

Types of Vaginal Prolapse

Vaginal prolapse is a general term that refers to a prolapse in the pelvic area. However, there are several specific types of prolapse that contribute to the overall condition of vaginal prolapse. It's helpful to know about each type, since many women may experience more than one.

Description: Vaginal vault prolapse

Vaginal Vault
For women who have had a hysterectomy the normal support from the uterus is no longer in place and prolapse can occur when the top portion of the vagina descends down into the lower vagina.

Vaginal vault prolapse
The apex, or upper portion of the vagina, collapses and descends into the vaginal canal. This sometimes occurs after a hysterectomy, causing the vagina to turn inside out

 

Description: Bladder prolapse

Bladder prolapse
(cystocele, pronounced "sist-uh-seal")-the bladder bulges or "herniates" into the vaginal wall

 

Description: Rectal prolapse

Rectal prolapse
(rectocele, pronounced "rekto-seal")-the rectum bulges (herniates) into the vagina

 

Description: Uterine prolapse

Uterine Prolapse
When the muscles and ligaments of a woman are weakened, and the woman still has a uterus, prolapse can occur when the uterus descends into the vagina.

Uterine prolapse
(procidentia, pronounced "pro-sid-entsha")-the uterus falls into the vagina

 

Description: Small bowel prolapse

Enterocele
Enterocele occurs when the intestine bulges into the vagina. Enterocele's can occur from the front, back or top. This illustration shows an enterocele from the back.

 

Treatment Options

Non-surgical treatment methods

Although there are no medications to treat vaginal prolapse, there are some simple treatments that do not require prolapse surgery. Women who are just beginning to experience symptoms of vaginal prolapse may opt for non-surgical methods as a first step. For women dealing with mild symptoms, these simple changes may be an effective vaginal prolapse treatment.

  • Managing symptoms-especially bladder or bowel symptoms. If you suffer from occasional loss of bladder control, absorbent pads, liners or adult diapers trap leaks away from the body and clothing, while also neutralizing odors. In the case of bowel symptoms, your physician may be able to offer ways to help improve bowel movements.

Note: Although bladder control problems may be caused by vaginal prolapse, sometimes women who experience urine leakage may not have vaginal prolapse, but instead may be suffering from stress urinary incontinence, a related condition. to learn more about this.

  • Behavior therapies-By making simple lifestyle changes-like losing weight, eating high fiber foods, stopping smoking, and avoiding heavy lifting or straining-some women are able to minimize the frequency and severity of their vaginal prolapse symptoms.

  • Medications-There are no medications used to treat vaginal prolapse.

  • Physical therapy-Many physicians or physical therapists recommend regular pelvic muscle exercises, known to many women as Kegel exercises. These may help strengthen the pelvic floor muscles and may relieve some symptoms of minor prolapse. Kegels are done by identifying the pelvic floor muscles (one way to locate these muscles is to try stopping the flow of urine when you're going to the bathroom). They're easy to learn and perform on your own-even while you're watching TV or driving, though they need to be done correctly and regularly.

    Note: Kegel exercises are a treatment only-have not been established as a way to prevent vaginal prolapse

  • Vaginal pessary-Also known as a uterine prolapse pessary, this is a device that is placed into the vagina to provide support to the related pelvic structures and relieve pressure on the bowel and bladder. These devises may be a ring or a donut shape, or a ring with support. The are usually made of silicone and fitted by a physician. Pessaries are usually used with patients who decline surgery, who may be poor candidates for surgery, or who need temporary relief of pregnancy related prolapse or incontinence.

http://www.amselevate.com/video/ele_ant_sur.wmv

Advanced minimally invasive surgical procedures

Prolapse repair surgery returns prolapsed organs to a more normal anatomical position and strengthens structures around your vagina to maintain support and suspension of organs.

Many women are turning to new, advanced minimally invasive treatment options because they:

  • Minimize tissue trauma
  • Restore normal anatomy with a faster recovery than traditional open abdominal prolapse surgery options
  • Minimize pain compared to more invasive procedures

Vaginal prolapse solutions-Surgical mesh

Many doctors now use mesh as a vaginal prolapse treatment. These mesh repairs may be as effective as traditional surgical procedures, while smaller incisions potentially minimize pain and recovery time.

Depending on your needs and the procedure performed, your doctor may be able to choose a graft made from either a synthetic mesh or a biologic mesh to repair the prolapse and restore your anatomy.

Description: Image1

 

What to expect during the procedure
Typically, these minimally invasive prolapse treatment procedures take place on an in-patient basis and are performed under general anesthesia. Minimally invasive mesh repair procedures generally follow these steps:

  • A vaginal incision and a few small skin incisions are made. You may either have an incision at the crease where your upper thigh meets your buttocks or in the middle of your buttocks on both sides.
  • The mesh is inserted through an incision, placed in the body, secured with stitches, and the incisions are closed.

The use of mesh in surgical procedures is not new, and is commonly used. Mesh used for vaginal prolapse surgery is light, soft, porous, and pliable, allowing your own body's tissues to grow in and around it. Once placed, you should not feel the mesh inside you.

What to expect afterwards
Your hospital stay will be determined by your doctor. Incisions will be small and should heal quickly so, depending on the nature of your work, you may be able to return to work after one to two weeks. However, you will need to refrain from sexual intercourse, heavy lifting, and rigorous exercise for six to eight weeks to allow your body to heal. Your doctor will provide you with additional information on how to care for yourself after surgery.

It's important to know that some patients experience incontinence that was hidden before surgery. Others may notice inflammation or irritation following their procedure. If this happens to you, consult your physician.

There are many different surgical options, so it's important to talk with your specialist to understand what's best for you, and why. If your doctor recommends a more invasive surgery over minimally invasive surgery, make sure you are fully aware of the risks and side effects beforehand. These surgeries are usually performed in a hospital under regional or general anesthesia, and the recovery period may be longer than for less invasive surgical procedures.

  • Sacral Colpopexy - This is a surgical procedure that attaches one end of mesh to the top of the vagina and the other end to the upper part of the tailbone. This is typically a more invasive surgical option.
  • Plication - This involves reattaching the weakened tissue to other tissue; although this may be less invasive.

Vaginal Prolapse Quiz

Question 1:
Have you ever felt a bulge or lump in your vagina?

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Yes

No

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Question 2:
Do you feel like something is falling out of your vagina-almost as if a tampon is sliding out of place?

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Yes

No

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Question 3:
Is intercourse uncomfortable-or even painful?

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Yes

No

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Question 4:
Do you experience vaginal pain, pressure, irritation, bleeding, or spotting?

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Yes

No

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Question 5:
Do you experience loss of bladder control, especially when coughing or sneezing?

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Yes

No

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Question 6:
Do you have difficulty with bowel movements?

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Yes

No

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Question 7:
Do you have a delayed or slowed urine stream?

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Yes

No

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Question 8:
Do you experience frequent lower back pain?

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Yes

No

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Do I have vaginal prolapse?

If you answered "Yes" to two or more questions, you may be suffering from some form of vaginal prolapse (also known as pelvic organ prolapse).

Remember to print out this quiz and take it to your next appointment. Your responses will go a long way toward helping your doctor make an accurate diagnosis-and finding a treatment option that's right for you.