• Pelvic Organ Prolapse

    Pelvic Organ Prolapse

Pelvic Organ Prolapse

Cystocele

In the case of the bladder, a bulge may develop on the top vaginal wall that causes a “cystocele”.

Rectocele

Similarly, the rectum can push upward on the bottom wall of the vagina causing a bulge.

Utero Vaginal Prolapse

In women with a uterus, a loss of support may cause the cervix to protrude through the vaginal canal.

Vaginal Vault Prolapse

In women who have had a hysterectomy, the apex of the vagina can fall through the vaginal canal.

These different forms of pelvic organ prolapsed may be difficult to distinguish because they all commonly form a vaginal bulge of some kind, and only a physician can reliably distinguish the type of prolapse by performing a detailed pelvic examination.

Click on the following link to read an article on female pelvic floor disorders written by Dr. Steinberg in Valley Health Magazine.

Observation

Fixing pelvic organ prolapse by surgery is usually recommended for patients that are symptomatic and for those having “quality of life” issues. If you have pelvic organ prolapse that is asymptomatic, then observing it with regular follow-up is reasonable. If you become symptomatic, then we can decide on other treatment options.

Pessary

A pessary is a device that is placed into the vagina to support the uterus and/or bladder and rectum for patients with pelvic organ prolapse. There are different types and shapes of pessary, but the most commonly used is a firm ring that presses against the wall of the vagina and urethra to help decrease leakage and support a prolapsed vagina or uterus. The type and size of the pessary should be fitted to meet the needs of your problem and the requirements of your anatomy. You should not feel the pessary if properly fitted.

Dr. Steinberg carries pessary’s in the office, and it can be placed during your visit with us should you decide on this treatment option first. Generally, the pessary will be placed and then you would follow-up in two weeks for a pessary check. Assuming everything is fine, you would need to come into the office every 3 months to have the pessary cleaned then reinserted.

Surgery

There are many surgical options for the treatment of pelvic organ prolapse. Surgery can be performed vaginally, abdominally, with or without removing the uterus, and with or without supportive graft material. In most instances, a graft material is used to restore normal support due to high failure rates without using grafts.

Vaginal surgery is a minimally invasive procedure that offers advantages over other techniques such as less operative time, less pain and quicker recovery. This procedure is performed by making an incision in the vagina and attaching graft material to ligaments within the pelvis to support the bladder, vagina, uterus or rectum. Women with a uterus may choose to either have it removed or left in place.

In some instances, abdominal surgery may be appropriate. Although this requires an abdominal incision and typically longer operative time, this procedure may provide the greatest chance of long-term success. However, this procedure is typically reserved for patients with uterine or vaginal (apical) prolapse. In this procedure, an abdominal incision is made to access the abdominal cavity. A mesh material is then used to “bridge” the vagina to the sacrum preventing vaginal prolapse.

Prior to undergoing surgery, patients undergo urodynamics testing in an attempt to predict leakage of urine that may possibly occur after the procedure. If this test is positive, a procedure to prevent leakage of urine would be performed at the time of surgery. Patients who have pre-existing urinary incontinence would also receive an anti-incontinent surgery during the procedure.

Press enter to search