Pelvic Prolapse

Pelvic prolapse or pelvic relaxation is very common in women over the age of 50 but is sometimes seen at an earlier age. It commonly results in a so-called “dropped bladder.” In addition to sagging of the bladder into the vagina (cystocele), pelvic prolapse can result in bulging of the rectum into the vagina (rectocele), collapse of the sides of the vaginal walls (paravaginal defect), and/or bulging of the intestine into the top of the vagina (enterocele). A urethrocele or decreased support of the tube leading out of the bladder is commonly seen with a cystocele. 
If you have not had a hysterectomy, the uterus (womb) may drop to varying degrees (uterine prolapse). Mild pelvic prolapse requires no treatment. If treatment is necessary, it is best to treat all of the support problems simultaneously to get the best long-term results. Pelvic prolapse is caused by tears in a tissue called fascia. Fascia is a strong canvas-like tissue that supports the bladder, vagina, and rectum. Similar tissue is also found in many other areas of the body.

The following drawing illustrates normal pelvic anatomy as viewed from the side with no prolapse:

The following drawings demonstrate the main types of pelvic prolapse:

A cystocele is a so-called “dropped bladder.”


 

A rectocele is a pouch from the rectum into the vagina.

 

Uterine prolapse results from loss of support of the uterus at the top of the vagina.

      

Factors that may increase pelvic prolapse include:

  • pregnancy with vaginal delivery
  • being overweight
  • chronic coughing (such as with smoking or chronic bronchitis)
  • heavy lifting
  • frequent straining
  • estrogen deficiency
  • long-distance running

Symptoms of Pelvic Prolapse

Symptoms resulting from pelvic prolapse can include:

  • pelvic pressure
  • pelvic and low back pain
  • pain with intercourse
  • urinary incontinence or loss of urine when laughing, coughing, sneezing, lifting, etc.
  • urinary retention and/or symptoms of recurrent bladder infection
  • vaginal irritation
  • difficulty having a bowel movement so you have to push on your bottom
  • the feeling that something is coming out of the vagina

Treatment of Pelvic Prolapse

If the prolapse is not severe, some patients respond to medical or non-surgical treatment of pelvic prolapse. Alternatives to surgery can include:

  • lifestyle modification such as quitting smoking, losing weight, and getting allergy treatments
  • Kegel’s exercises which are regular contraction of the muscles that allow you to stop urine in mid-stream – this may reduce or eliminate incontinence
  • pessary use which is usually a donut-shaped rubber or plastic device inserted into the vagina to provide support
  • hormonal (estrogen) replacement therapy – this is controversial
  • treatment with medication that helps certain types of incontinence.

Surgery for Pelvic Prolapse

If pelvic prolapse surgery is necessary, a number of different procedures may be performed. The choice of procedure(s) depends on the specific problem(s), any associated problems, and the preference and skill of your physician.

  • hysterectomy is frequently performed if there is uterine prolapse and if the patient does not want to have more children – otherwise uterine suspension may be done to preserve the uterus
  • pelvic prolapse repair may be done vaginally, laparoscopically, or with an abdominal incision
  • suburethral sling may be used to treat urinary incontinence

Pelvic Prolapse Surgery – More Info

Pelvic prolapse can be severe and debilitating. Many advances have been made in recent years in the surgical treatment of pelvic prolapse. The surgeries are performed by an abdominal or vaginal approach or a combination of the two. Abdominal repair can be completed through a large incision (laparotomy) or laparoscopically through several small incisions. Depending on the particular type of prolapse, a vaginal approach may be used alone or in combination with an abdominal approach. To give the best chance for long-term success of the treatment, the physician should have the ability to perform a number of different repairs – and if the repairs need to be performed abdominally, it is preferable these be done laparoscopically to hasten recovery.
Several laparoscopic procedures for treatment of pelvic prolapse require special expertise to perform the procedures. These include the Burch procedure, paravaginal repair, and sacral colpopexy. With these procedures, the physician must have the ability to suture laparoscopically, which is quite different from suturing through a large incision. Dr. Biggerstaff is one of a limited number of physicians in the region currently performing all of these procedures.

Other advances in the surgical treatment of pelvic prolapse include the use of synthetic mesh and grafts. The use of these new materials and techniques is designed to give better long-term results.

 

The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.

 Advanced Healthcare for Women
5354 Reynolds Street, Suite 518
Candler Professional Building
Savannah, Georgia 31405
 
Telephone 912-355-7717
Fax 912-355-0979
gyndoc@bellsouth.net