What is Pelvic Organ Prolapse?

Pelvic organ prolapse is the bulging of pelvic organs into the vaginal canal due to a weak pelvic floor, causing symptoms like discomfort, pain, urinary problems, and constipation. The pelvic floor is a group of muscles that support the pelvic organs, which are made up of the bladder, rectum, small bowel, uterus, and vagina. Vaginal childbirth, menopause, pelvic surgery, radiation treatments, or being extremely overweight may cause the pelvic floor to weaken. Pelvic organ prolapse is a very common disorder among women, particularly for those who are over 50.

The choice of treatment for pelvic organ prolapse depends on the severity of the condition. Mild to moderate prolapse may be managed by doing pelvic floor strengthening exercises, taking hormone replacement therapy, or using pessaries. Pessaries are small devices inserted into the vagina to help support the pelvic organs. Pessary fitting is a quick procedure done in a doctor's office. For severe prolapse, surgical treatment may be necessary. Pelvic organ prolapse surgery repairs the following:

  • Cystocele or bladder prolapse, where the bladder sags into the vagina. The surgeon repairs a cystocele by strengthening the front wall of the vagina using stitches so that the bladder will no longer sag.
  • Enterocele or small bowel prolapse, which occurs when the small bowel descends towards the vagina. To correct an enterocele, the tissues between the small bowel and the vagina are sewn together, allowing them to provide more support.
  • Rectocele or posterior prolapse, which is the bulging of the front wall of the rectum into the back wall of the vagina. Surgery to repair a rectocele removes the excess stretched tissue between the rectum and vagina.
  • Uterine prolapse, which occurs when the uterus slips down to the vagina. To treat a uterine prolapse, the surgeon may secure the neck of the uterus (called cervix) to a ligament in the pelvis using stitches. Another option for this type of prolapse is a vaginal hysterectomy, which is the removal of the uterus.
Each of these procedures is performed through a vaginal incision, but an enterocele repair may use the abdominal approach as an alternative. If two or more pelvic organs have prolapsed, a combination of any of these procedures may be performed during the same surgical session.

For women who no longer wish to have intercourse, an operation called colpocleisis may be a surgical option as well. By closing the vaginal canal, colpocleisis treats pelvic organ prolapse and eliminates any risk of its recurrence.

In most instances, pelvic organ prolapse surgery only requires a hospital stay of one day. You may experience vaginal bleeding for the first few weeks following surgery. If this happens, you should use sanitary pads rather than tampons, as a higher risk of infection is associated with the use of tampons. To further help with your recovery, you should begin doing gentle pelvic floor strengthening exercises a few days after surgery. Doing these exercises at least three times a day as a routine tightens your pelvic floor muscles and prevents the recurrence of prolapse.

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