Pelvic Organ Prolapse
Pelvic organ prolapse, also known as uterine prolapse, is a condition that
occurs when the normal support of the vagina is weakened and the uterus
begins to slide from its normal position. The uterus may slip enough that
it drops partially into the vaginal canal, or in severe cases, the uterus
slips so far that some of the tissue protrudes outside of the vaginal opening.
Symptoms
Women with mild cases of pelvic organ prolapse may not experience any symptoms.
However, as the uterus slips further out of position, it can place pressure
on other pelvic organs causing a variety of symptoms, such as heaviness,
pain or pressure in the pelvis; pain during intercourse; urinary incontinence,
frequency or urgency; recurrent bladder infections; lower back pain; etc.
Causes
Pelvic organ prolapse is most common in postmenopausal women. Weakened
pelvic muscles and connective tissues are generally the cause of uterine
prolapse, which is often the result of vaginal childbirth, previous vaginal
surgeries, loss of estrogen, and repeated straining or heavy lifting over
the years. Each of these can weaken the pelvic floor and lead to pelvic
organ prolapse.
Treatment Options
To determine if pelvic organ prolapse is the cause of your symptoms, your
physician will perform a thorough pelvic examination to check the position
of your uterus and assess the degree of the prolapse and the strength
of your pelvic floor muscles. Your physician may also ask you to complete
a questionnaire about your symptoms and review this with you to determine
the best treatment option based on your personal health and lifestyle.
Generally, imaging tests are not necessary to diagnose pelvic organ prolapse,
however, they can be helpful in assessing the degree of prolapse. Therefore,
your physician may recommend ultrasound or magnetic resonance imaging
(MRI) to further evaluate your condition.
When it comes to treating pelvic organ prolapse there are several surgical
and non-surgical treatment options. The course of treatment will depend
on the degree of prolapse, as well as the individual’s health and
lifestyle. Treatment options for uterine prolapse include:
Non-surgical options
In mild cases of pelvic organ prolapse, treatment is usually not necessary.
However, several lifestyle changes may be recommended such as:
- Kegel exercises to improve pelvic floor muscle tone, since over time you
may continue to lose tone, making the prolapse more severe.
- Achieve and maintain a healthy weight to minimize the stress on the pelvic floor.
- Avoid heavy lifting and straining, to reduce strain and pressure on supportive
pelvic structures.
For mild to moderate cases of pelvic organ prolapse, there are several
non-surgical options that may be recommended such as:
- A vaginal pessary, which is a removable device that fits inside the vagina
and helps to hold the uterus in place. Vaginal pessaries come in many
shapes and sizes, so your physician will measure and fit you for a device,
if this is the recommended course of treatment. When deciding to use a
vaginal pessary, it’s important to discuss the benefits and drawbacks
of using this device.
- Estrogen replacement therapy, which may help to limit further weakening
of the pelvic floor muscles and other supportive connective tissues. There
are some concerns with taking estrogen, which is why patients should thoroughly
discuss the risks and benefits of this option with their physician.
Surgical options
For moderate to severe cases of pelvic organ prolapse, the most effective
treatment option and “gold standard of care” is sacrocolpopexy.
This option utilizes a surgical mesh to hold the uterus in place, which
in turn, resolves a woman’s symptoms. Sacrocolpopexy can be performed
laparoscopically, offering a minimally invasive alternative to open surgery.
A more precise and less-invasive option is robotic-assisted sacrocolpopexy,
which allows surgeons to more clearly view the pelvic structures using
3D technology. Robotic-assisted surgery provides may benefits to patients,
including less post-operative pain, less risk of complications, a shorter
hospital stay and quicker recovery.
Expert Care
At Hoag, our multidisciplinary team of pelvic health experts consists of
urogynecologists, gynecologists and other subspecialists who work together
to provide a coordinated approach in the treatment of pelvic health issues.
Hoag’s pelvic health team works together to provide a coordinated
approach in the treatment of pelvic organ prolapse, including the latest
progressive treatment options personalized to meet the needs of the individual patient.
If surgery is necessary, Hoag’s expert team is well versed in the
full gamut of minimally invasive laparoscopic techniques, including robotic-assisted
surgery utilizing the state-of-the-art da Vinci® Surgical System.
For more information about the diagnosis and treatment of pelvic organ
prolapse, please speak with your physician, or locate a Hoag-affiliated
physician near you.