Pelvic Organ Prolapse (POP)
The pelvic floor is a group of muscles that form a sling or hammock across the opening of a woman's pelvis. These muscles, along with connective tissues, ligaments and nerves keep all of the pelvic organs in place and control the rectum, uterus, vagina and bladder.
Pelvic organ prolapse (POP) occurs when pelvic muscles and tissues become weakened, stretched or are injured as a result of childbirth, repeated heavy lifting, chronic disease, obesity or surgery. When the pelvic floor tissues which hold pelvic organs in place become weakened or stretched, it can cause the pelvic organs to bulge (or prolapse) into the vagina. The pelvic organs may prolapse past the vaginal opening, and more than one pelvic organ can prolapse at the same time.
Pelvic organ prolapse is a common, treatable medical condition which affects an estimated one third of all women — and half of all women ages 55 and older. While pelvic organ prolapsed can affect women of all ages, the risk of developing POP increases with age. Post-menopausal women are at the highest risk for developing POP.
Pelvic organ prolapse may include one, or more, of these conditions:
- Bladder prolapse (cystocele): The front wall of the vagina (pubocervical fascia) weakened and the bladder pushes against the vagina. Pelvic pressure or protrusion are common symptoms. Also, urinary stress incontinence — urine leakage during coughing, sneezing, laughing or exercising — related to weakness of the urethra may also be a symptom.
- Rectum prolapse (rectocele): The back way of the vagina (rectovaginal fascia) weakens and the rectum pushes against the vagina. Pelvic pressure, protrusion and difficulty with bowel movements may occur.
- Uterus, or womb, prolapse (procidentia): A group of ligaments — uterosacral and cardinal — located at the top of the vagina weaken, causing the uterus to fall, weakening both the front and back walls of the vagina.
- Vaginal vault prolapse: The top of the vagina falls toward the vaginal opening, which can cause the walls of the vagina to weaken. This condition can progress to a point where the top of the vagina may protrude outside the body through the vaginal opening, turning the vagina "inside out." This type of prolapse may occur after a hysterectomy surgery since the uterus provides support for the top of the vagina. About 10% of women who undergo a hysterectomy develop some degree of vaginal vault prolapse.
What are the symptoms of POP?
Patients with pelvic organ prolapse may experience the following symptoms:
- Bowel or bladder incontinence
- Prolapsed uterus, bladder, vagina or rectum
- Difficulty in urinating or moving the bowels
- Pelvic or bladder pain or pressure
- Frequent urination
A Summa urogynecologist can recommend a variety of therapies to relieve the symptoms of prolapse, urinary or fecal incontinence or other pelvic floor symptoms. Your doctor may recommend either a conservative treatment or a surgical option, dependent on your overall health and the severity of your condition.
A few of the conservative, or non-surgical, treatments include:
- Medications: This may improve bladder or bowel control by blocking signals from the nervous system that can cause urgency
- Pelvic exercise (Kegels) or physical therapy: Use to strengthen pelvic muscles
- Behavioral and/or dietary modifications
- Vaginal devices (pessaries): These are inserted into the vagina and provide additional support for pelvic organs.
- Biofeedback and electric stimulation therapies: Used to improve bladder and bowel control
- Vaginal estrogen hormone replacement therapy: This treatment may reduce weakness in the pelvic floor.
Your doctor may determine a surgical option is necessary to treat POP and/or urinary incontinence. The surgery is minimally invasive and designed to provide permanent support for pelvic organs. Typically, these procedures can be performed on an outpatient or overnight basis.
Surgery options include:
- Colpopexy: Repositioning of the vagina to its correct position on the pelvic cavity.
- Urethral sling: Used in the treatment of stress incontinence, synthetic or biologic tape is used to support the urethra.
- Vaginal mesh: In this minimally invasive procedure, small incisions are made in the vagina. Mesh is then attached to provide support to the bladder or rectum. This procedure is typically used for older women who are not sexually active.
- Laparoscopic uterine suspension: The vagina is attached to ligaments located in the back of the pelvis. This treatment is usually performed when preservation of the uterus is desired, and is usually done in conjunction with a vaginal vault suspension.
- Cobaltite® injections: Water-based gel containing particles made of calcium hydroxylapatite is injected around the urethra to build up the area and tighten the sphincter muscles near the bladder opening.
- Mid-urethral sling procedure: A small incision is made in the vagina and a sling is placed under the urethra and is attached to the connective tissue in the pelvis.
- Pubovaginal slings: Similar to the mid-urethral sling procedure, but instead a biologic tissue is used instead of a synthetic material to create a sling under the urethra.
- Robotic-assisted surgery: This type of minimally invasive surgery is performed by using a special machine (robot) to conduct the surgery through small incisions in the abdomen. Though called a robot, the machine does not act on its own, but is an extension of the surgeon's hands. They control the robot's actions, which translates hand movements into small, precise movements of tiny instruments inside the body. The robot's camera and lighting system also provide your surgeon with a magnified, high-definition, three-dimensional (3D) view of the surgical field. Minimally invasive techniques provide benefits to patients, including: less post-operative pain, faster recovery times, less bleeding and less scarring.
However, minimally invasive robotic surgery may not be the best option for everyone. Your physician can explain all of the options available to treat your condition, including whether you're a good candidate for minimally invasive robotic surgery.
Read more about Summa's use of the daVinci robotic-assisted system for minimally invasive surgery.
Summa has four fellowship-trained urogynecological specialists with more than 70 years of combined experience — including the only female urogynecologist in the five-county area (Medina, Portage, Stark, Summit and Wayne counties).
For more information or to schedule an appointment for a pelvic exam, click or call (800) 237-8662.