About Prolapse
The uterus is held in position by pelvic muscles, ligaments and other tissues. If the uterus drops out of its normal position, this is called prolapse. Prolapse is defined as a body part falling or slipping out of position. Prolapse happens when the pelvic muscles and connective tissues weaken. The uterus can slip to the extent that it drops partially into the vagina and creates a noticeable lump or bulge. This is called incomplete prolapse. Complete prolapse occurs when the uterus slips to such a degree that some uterine tissue is outside the vagina.
Pelvic prolapse is usually accompanied by some degree of vaginal vault prolapse. Vaginal vault prolapse occurs when the upper part of the vagina loses its shape and sags into the vaginal canal or outside the vagina. Pelvic prolapse may also involve sagging or slipping of other pelvic organs, including the bladder, the urethra which is the tube next to the vagina that allows urine to leave your body, and rectum.
Signs & Symptoms
Women with mild cases of pelvic prolapse may have no noticeable symptoms. However, as the uterus falls further out of position, it can place pressure on other pelvic organs—such as the bladder or bowel — causing a variety of symptoms, including:
- Sensation of sitting on a small ball
- Heaviness or pulling in the pelvis
- Pelvic or abdominal pain
- Pain during intercourse
- Protrusion of tissue from the opening of the vagina
- Repeated bladder infections
- Vaginal bleeding or an unusual or excessive discharge
- Constipation
- Frequent urination or an urgent need to empty your bladder
Symptoms may worsen with prolonged standing or walking due to added pressure placed on the pelvic muscles by gravity.
Causes and Risk Factors
Pelvic prolapse is fairly common and the risk of developing the condition increases with age. It can occur in women who have had one or more vaginal births. Normal aging and lack of estrogen after menopause may also cause pelvic prolapse. Chronic coughing, heavy lifting and obesity increase the pressure on the pelvic floor and may contribute to the condition. Although rare, pelvic prolapse can also be caused by a pelvic tumor. Chronic constipation and the pushing associated with it can worsen pelvic prolapse.
Screening & Diagnosis
Diagnosing pelvic prolapse requires a pelvic examination usually performed by a gynecologist. The doctor will ask about your medical history and perform a complete pelvic examination to check for signs of pelvic prolapse. You may be examined while lying down and standing. Imaging tests, such as ultrasound or magnetic resonance imaging (MRI), may be performed to further evaluate the pelvic prolapse.
Treatments
Most women seek treatment before the time the uterus drops to the opening of the vagina. Losing weight, stopping smoking, and getting proper treatment for contributing medical problems, such as diseases that induce chronic cough, may slow the progression of pelvic prolapse.
If you have very mild pelvic prolapse – without any symptoms – or very mild symptoms, surgical treatment is usually unnecessary. However, keep in mind that without any treatment, you may continue to lose uterine support, which could cause more severe symptoms. We recommend evaluation by a Pelvic Floor Physical Therapist to assess what action may be necessary to treat your specific needs.
Non-Surgical Prolapse Treatment Options
Pelvic Floor Physical TherapyÂ
Nicole Bobay is our in-office Pelvic Floor Physical Therapist, with certifications as a Women’s Health Specialist and Integrated Manual Therapist (PT, MPT, WCS, CIMT). If you are experiencing symptoms of pelvic prolapse, we highly recommend making an appointment with Nicole as well as attending her monthly seminar: The Core, Pelvic Floor & More. Her seminar is a wonderful introduction to the world of Pelvic Floor Physical Therapy to kick-start your healing while you anticipate your first appointment. In your appointment, Nicole will work with you to create a treatment program specific to your needs based on your symptoms and health history.
Estrogen Replacement Therapy
ERT refers to a woman taking supplements of hormones such as estrogen alone or estrogen with another hormone called progesterone. ERT replaces hormones that a woman’s body should be making or used to make. Taking estrogen may help to limit further weakness of the muscles and other connective tissues that support the uterus. However, there are some drawbacks to taking estrogen, such as an increased risk of blood clots, gallbladder disease and breast cancer. The decision to use ERT must be made with your doctor after carefully weighing all of the risks and benefits.
Vaginal Pessary
A pessary is a rubber or plastic doughnut-shaped device that fits around or under the lower part of the uterus (cervix), helping to prop up the uterus and hold it in place. A health care provider will fit and insert the pessary, which must be cleaned frequently and removed before sex.
da Vinci® Surgical Treatment Options
For some women, surgery may be the best treatment option to repair pelvic prolapse, including vaginal vault prolapse. Your doctor will perform a physical exam to determine the best way to completely repair the prolapse. Pelvic prolapse surgery is known as sacrocolpopexy. Surgical mesh is used to hold the affected pelvic organ(s) in the correct anatomical position. This procedure can also be performed after a hysterectomy to treat uterine prolapse. It provides long-term support of the vagina.
Benefits over Non-Robotic Surgery
The da Vinci System is a state-of-the-art robotic surgical platform with 3D, high-definition vision and miniaturized, wristed instruments designed to help doctors take surgery beyond the limits of the human hand. Your doctor controls the da Vinci System which translates their hand movements into more precise movements of miniaturized instruments inside your body.
-
Less blood loss
-
Minimal need for blood transfusions
-
Shorter operations
-
Shorter hospital stay
-
Small incisions for minimal scarring
DISCLAIMERS
As with any surgery, these benefits cannot be guaranteed since surgery is specific to each patient, condition and procedure. It is important to talk to your doctor about all treatment options, including the risks and benefits. This information can help you to make the best decision for your situation.
While clinical studies support the effectiveness of the da Vinci Surgical System when used in minimally invasive surgery, individual results may vary. There are no guarantees of outcome. All surgeries involve the risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Surgery with the da Vinci Surgical System may not be appropriate for every individual; it may not be applicable to your condition. Always ask your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whether da Vinci Surgery is appropriate for your situation. The clinical information and opinions, including any inaccuracies expressed in this material by patients or doctor about da Vinci Surgery are not necessarily those of Intuitive Surgical, Inc. and should not be considered as substitute for medical advice provided by your doctor.