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.
Uterine Prolapse 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.
Uterine Prolapse 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.
Uterine 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 Treatment 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.
Pelvic Organ Prolapse Surgery
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 Pelvic Health 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.