Pelvic Organ Prolapse
Pelvic organ prolapse is the bulging of one or more pelvic structures into the vagina and, at times, out of the vaginal opening. The vagina is surrounded by a variety of pelvic structures. The rectum is beneath the vagina, the bladder on top of it, and the uterus, bowel, and the rest of the abdominal contents are behind it. When the support between one of these structures and the vagina weakens, prolapse can occur. Risk factors for all types of prolapse include childbirth, other pelvic trauma, connective tissue disorders, straining, and the aging process. The most common symptoms of prolapse is a sensation of pelvic pressure/heaviness or protrusion of tissue from the vagina, patient may define it as a feeling that something is “falling out” of the vagina.
Types of Prolapse
Cystocele (“dropped bladder”): Herniation of the bladder with associated descent of the interior vaginal segment.
Cystourethrocele: A Cystocell combined with distal prolapse of the urethra (bladder neck) with or with out associated urethral hyper-mobility.
Rectocele: The herniation of the rectum with associated descent of the posterior vaginal segment.
Uterine Prolapse: Descent of the uterus and cervix into the lower vagina, hymenal ring or through the vaginal interoitus. This occurs when the ligaments that support the uterus weaken, causing the back wall of the uterus to “give way” allowing the uterus and cervix to move towards the front of the vagina.
Enterocele: This type of prolapse usually occurs in patients who have had a hysterectomy where the support of the pelvic ligaments has been disrupted. The small bowel, enclosed within a hernia sac, can protrude into the vagina.
Vaginal Vault Prolapse: Descent of the vaginal appex (following hysterectomy) into the lower vagina, hymenal ring or through the vaginal interoitus.
Diagnosis and Treatment
Diagnosis of prolapse is based on characteristic findings upon physical exam. Management is guided by both the severity of symptoms and the severity of prolapse. The possibilities are: observation alone, pessaries (devices which are placed into the vagina for symptom relief ), and various vaginal or laparoscopic re-corrective surgeries.
To find out more information on Pelvic Organ Prolapse, or to find out if you are a good candidate for the treatment of this condition, contact a representative at Nezhat Medical Center to request an in-office consultation with Dr. Ceana Nezhat.