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Treatment

Many women who have a pelvic prolapse experience no symptoms and require no treatment. If your symptoms are bothersome or disrupting your life, there are various options. Which treatment option is right for you will depend on factors such as which organ(s) are affected, the nature and severity of your symptoms, whether you are considering having children, and your age. Your doctor may recommend lifestyle changes, using a pessary or surgery.

Lifestyle Changes

Many women find that lifestyle changes can help relieve their symptoms. These lifestyle changes include:

  • doing Kegel exercises to strengthen the muscles of the pelvic floor
  • eating high-fibre foods to avoid constipation
  • reducing the amount of coffee and caffeinated beverages consumed and drinking more water
  • avoiding heavy lifting

Pessaries

Another non-surgical option for treating pelvic prolapse is a pessary. A pessary is a device that is inserted into the vagina to support the prolapsed uterus or bladder and prevent symptoms such as urinary incontinence and pelvic pain. The device can increase the tightness of the pelvic muscles. It can be used as a temporary or permanent treatment. It is generally less useful for women with a rectocele or severe prolapse.

Pessaries are made of plastic or silicone. They often look a lot like either a diaphragm or a doughnut, although they come in a variety of shapes and sizes.

A pessary must be fitted by a health-care professional. Once fitted, you can remove and insert the device yourself. Your doctor will show you how to do this. The same pessary can be kept in the vagina for up to three months, but ideally, should be removed and cleaned regularly. How often you need to clean your pessary will depend on the type of prolapse you have and the type of pessary you are using. Many types can remain in place during sexual intercourse. Silicone pessaries can last for up to five years.

A pessary does have a number of potential drawbacks and risks, although many women who use pessaries do not have any problems. Even with careful cleaning, a pessary can increase your risk of infection, and may cause irritation or ulceration of the vaginal wall, especially if it does not fit correctly. Some women report a foul-smelling discharge. Pessaries can also interfere with sexual activity. Your health-care professional should check your pessary regularly to ensure that it fits you properly.

Surgery

Surgery for pelvic prolapse can relieve or at least reduce symptoms associated with a prolapse, such as incontinence, constipation and painful intercourse. The long-term success rate of prolapse surgeries varies depending on the type of surgery, but on average, about one third of women end up needing a second surgery within a few years.

Surgery for pelvic prolapse has two purposes:

  • to return the organ that has shifted to a more natural position and secure it in place
  • to reinforce the pelvic floor muscles in the weakened area so that further damage will not occur

In some cases, a hysterectomy (the removal of the uterus) may also be part of this surgery, depending on the type of prolapse. Although this is common, it is not always essential for successful surgery. For more on this question, read our Frequently Asked Questions section.

Many different surgical techniques are used to accomplish these goals. Often organs are anchored to fixed pelvic structures, such as the tissue around the pubic bone, using surgical sutures or staples. Openings in the pelvic floor muscles are sewn shut. Sometimes several layers of stitches are used to reinforce the muscles. In other cases, the web of pelvic floor muscles may be reinforced using synthetic materials such as mesh-like tapes. Tissue then forms around the tape and holds it in place. Before having surgery, your doctor should be sure that the diagnosis is accurate so that you receive the appropriate surgery.

Types of surgery for a pelvic prolapse include:

  • Abdominal surgery (laparotomy)
  • Laparoscopic surgery
  • Vaginal surgery
  • Combined surgery

Laparotomy
Open abdominal surgery is called a laparotomy. During a laparotomy, the surgeon may use any of the techniques described above to reinforce the structures supporting the vagina and bladder.

A laparotomy usually requires an incision several inches in length in the bikini area. It will likely take at least four to six weeks to fully recover.

Laparascopic Surgery
For laparascopic procedures, the surgeon uses a telescope-like device, called a laparoscope, to operate through one or more small incisions. These incisions are usually about a quarter inch in length and made around the belly button and groin.

After laparoscopic surgery, most women can leave the hospital and go home within 24 hours. Many can return to their normal activities within seven to 14 days. If complications develop during surgery, an abdominal incision may be necessary to complete the procedure.

Vaginal Surgery
During vaginal surgery, the surgical incision is made inside the vagina. This is a particularly effective method for certain types of cystocele that impair bladder function. Synthetic reinforcements to the pelvic floor muscles may also be put in place via vaginal surgery. A hysterectomy can also be done vaginally if you and your doctor decide to make this part of the procedure. The recovery time will depend on the procedures involved, but vaginal procedures generally require a shorter hospital stay and recovery time than open abdominal surgery.

Combined Surgery
For patients with extensive prolapse, prolapse that involves several different structures and/or prolapse that is associated with stress urinary incontinence, a combination of abdominal surgery (laparoscopy or laparotomy) and vaginal surgery is often recommended. If combined surgery is appropriate for your prolapse, your doctor will review the details of it with you.

Discuss with your doctor which of these procedures is most appropriate for your condition. All surgeries have risks, including the risk of infection and the possibility of damaging other organs. Damage to the pelvic muscles or organs can result in chronic pelvic pain. There are also risks associated with the use of anesthetic during surgery. All of these complications are uncommon, although the risk of infection is greater in cases where a synthetic material is inserted to provide support.

The risk of infection is also higher for a procedure that involves the bowel, such as the repair of a rectocele. If a rectocele is being surgically repaired, you will receive an enema before the procedure, to clean the bowel and help prevent infection. Antibiotics are generally given before any abdominal surgery to help prevent infection.

After Surgery
After surgery it is important to avoid further stress and damage to the pelvic floor muscles. You will be advised not to exercise for at least two weeks after surgery, and many doctors recommend lifting no more than 10 pounds for up to three months following surgery. Even after this time, it is wise to be cautious. Many doctors report, based on anecdotal evidence, that the need for further treatment is often associated with heavy lifting (e.g. moving furniture) or other strenuous activity. It is also important to try and avoid becoming constipated after surgery, as repetitive straining increases the risk of failure/early recurrence. Your doctor will likely recommend stool softeners, a high-fibre diet and possibly a laxative.

Once you have completely healed from surgery, you may want to begin exercises to help protect and strengthen your pelvic muscles. Talk to your doctor about when it is appropriate for you to start. Your doctor may be able to refer you to a physiotherapist to help you learn these exercises. Some exercises are discussed in the Urinary Incontinence section.

 

The pelvic floor is a layer of muscles that stretches like a hammock from the pubic bone at the front of the pelvis to the base of the spine in the back. These muscles support the weight of the pelvic organs and enable everyday activities like walking and sitting. Ligaments within the pelvis hold the organs in place.

The pelvic floor muscles also play a crucial role in the functioning of pelvic organs. For example, bands of muscle encircle the urethra (the opening you urinate through) and bowel. These bands are called sphincters. Sphincters control the release of urine and feces. Other muscles surrounding these organs control the filling and emptying of the bowel and bladder.

Muscles throughout the pelvis also work when a woman gives birth. Some of these same muscles contribute to the enjoyable sensations of female orgasm.

Damage or weakness in these muscles can interfere with all of these functions. One of the most obvious signs of damage is a prolapse.

Think of the pelvic floor as a mesh of muscles, like a nylon stocking. When these muscles are weakened or damaged, runs or even holes appear in the mesh and it can no longer support the pelvic organs. A prolapsed organ is an organ that has shifted position and begun to protrude through this mesh. Most commonly, prolapsed organs press down against the vagina, since this is the largest opening to the pelvic floor. This causes a bulge in the wall of the vagina. In severe cases, a prolapse can push part of the vaginal wall out through the vaginal opening.

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Pelvic Prolapse

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