Prolapse surgery

Pelvic organ prolapsed refers to the loss of support of the pelvic organs and their descent into the vagina.  The pelvic organs consist of the uterus, vaginal, bowel and bladder. Pelvic organ prolapse occurs when the muscles, ligaments and fascia that hold these organs in their correct positions become weakened.

Symptoms

  • Vaginal bulging – complaint of a bulge or ‘something coming down’, able to feel bulge by direct contact or able to see using a mirror.
  • Pelvic pressure – complaint of increased heaviness or dragging in the suprapubic, perineum or pelvic region.
  • History of urinary hesitancy, slow flow, urgency, stress incontinence, history of recurrent infections, post defecation soiling.
  • Bleeding, discharge, infections related to ulceration of the prolapsed.
  • Splinting/digitations – the need to digitally replace the prolapsed or otherwise apply manual pressure to assist with voiding or defecation.
  • Discomfort during sexual intercourse.

Types of Prolapse

An anterior prolapse, also known as cystocele, occurs when the supportive tissue between the woman’s bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina.

A posterior prolapsed, also known as rectocele, occurs when the thin wall of fibrous tissue the separates the rectum from the vagina weakens, allowing the vaginal wall to bulge.

Uterine/cervical prolapse is the descent of the uterus or uterine cervix.

Vaginal vault (cuff scar) prolaspe is the descent of the vaginal vault (cuff scar following hysterectomy).

Causes

  • Childbirth – Damage to ligaments, nerves and muscles following childbirth
  • Age and menopause – weakening of pelvic floor muscles
  • Obesity
  • Chronic constipation/straining
  • Chronic cough
  • Heavy lifting

Pelvic organ prolapse can be managed a number of ways

Pessaries

A pessary is a device inserted into the vaginal to support the walls and related organs. Majority of pessaries are made of silicone which has the advantage of a long life. Refer to Pessary Patient information handout.

Pelvic floor exercises:  Pelvic floor exercises may be helpful in improving or preventing worsening of early stages of prolapsed. Pelvic floor exercises require times, motivation and proper technique.

Lifestyle management

Changes to help reduce intraabdominal pressure which can exacerbate symptoms include weight loss, avoid heavy lifting, avoid constipation and try to manage chronic coughing.

Surgery

For some women a surgical repair may be offered to restore your pelvic organs to their natural position whilst retaining sexual function.  Surgery may be approached vaginally, abdominally or via laparoscopic or robotic. Your doctor will discuss the most appropriate surgical treatment for you.