Pelvic Organ Prolapse (dropped bladder, bowel, rectum, uterus)
As you age, your organs can shift positions. Pregnancy, childbirth or extra weight can stretch and weaken muscles that support your pelvic organs. A sheet of muscles and ligaments called the pelvic floor supports the uterus, small bowel, colon and bladder. If pelvic floor muscles are weak, your organs may drop and bulge into the vagina. When that happens, you may feel like something is falling out of your vagina or you may have a sensation of fullness or pain. It can also become difficult to hold urine or have a bowel movement.
There are several types of prolapse:
- · Cystocele--tissues between the vagina and bladder weaken, and the bladder falls into the vagina
- · Rectocele--tissues between the vagina and rectum weaken, and the rectum falls into the vagina
- · Enterocele--the small bowel falls through the apex of the vagina, often after a hysterectomy
- · Uterine prolapse--the uterus descends into the vaginal vault, or in severe cases, outside of the vagina
Risk factors include previous childbirth (usually more than one vaginal delivery), chronic constipation, coughing, as from chronic bronchitis or smoking, obesity, age, hysterectomy and menopause. There also may be slight genetic risk.
You may have a single prolapse or a combination. We can determine this through a pelvic examination. Because prolapse is associated with aging and low estrogen levels, topical estrogen creams or vaginal tablets may be prescribed. They can strengthen tissues and promote surgical healing, without entering your bloodstream in significant quantities. If you have total prolapse, surgery may be necessary. We have a highly specialized team experienced in open and robotic vaginal surgery.
Prolapse may occur with or without stress incontinence, urge incontinence or mixed incontinence. We will treat them together.
Cystocele (Dropped Bladder)
You may feel a bulging in the vaginal area or a fullness or pressure in the pelvis or vagina, or you may feel like you are sitting on a ball. The sensation may go away when you lie down. You may feel discomfort when you cough or lift something. You may feel like you are not emptying your bladder completely, or may leak urine when you laugh, cough or sneeze. Intercourse may be painful, and you may have frequent bladder infections.
Treatment options range from no treatment for a mild cystocele to surgery for a serious cystocele. If a cystocele is not bothersome, you may need only to avoid heavy lifting or straining that could cause the cystocele to worsen. If symptoms are moderately bothersome, we may recommend a pessary--a ring-like device placed in the vagina to hold the bladder in place.
Large cystoceles may require surgery to move and keep the bladder in a more normal position. The tissues between the vagina and bladder can be tightened and supported with sutures or with a mesh insert.
Pelvic floor physical therapy can help strengthen tissues. You also should avoid smoking, gaining weight, bearing down, straining and coughing as much as possible.
Rectocele (Dropped Rectum)
You may feel a fullness or pressure in the vaginal area, and have trouble passing stool. You may also feel rectal pressure or fullness, and feel that you can't completely empty your bowel. You may experience discomfort with intercourse.
Diagnosis is made with a pelvic and rectal exam. Treatment for mild prolapse may include pelvic floor physical therapy and stool softeners to avoid constipation and straining. For severe prolapse, we can perform surgery to strengthen and support the tissues between the vagina and rectum with sutures.
Enterocele (Dropped Bowel)
Less common than other types of prolapse, this generally only occurs after the uterus has been removed. Symptoms include a feeling of fullness, pressure or pain in the vaginal and pelvic area, a pulling sensation or low back pain that eases when you lie down, and painful intercourse.
Enterocele is diagnosed through a pelvic exam. It can be treated with a pessary--a ring-like device placed in the vagina to hold the bowel in place--or surgery. A pessary needs to be replaced periodically to avoid infection or ulcers. Surgery involves pushing the bowel back into place and using sutures to tighten muscles and ligaments that support it.
We will refer you to a gynecologist for treatment.
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