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CONDITIONS

Pelvic Organ Prolapse

What is Pelvic Organ Prolapse?

Under normal conditions in women, the bladder is held in place by a “hammock” of supportive pelvic floor muscles and tissue. When these tissues are stretched and/or become weak, the bladder can drop and bulge through this layer and into the vagina. This results in bladder prolapse, also called cystocele. In severe cases, the prolapsed bladder can appear at the opening of the vagina. Sometimes it can even protrude (drop) through the vaginal opening. Bladder prolapse is common in women. The symptoms of bladder prolapse can be bothersome but it can be treated.

Symptoms

The most common symptom is the feeling of a vaginal bulge. A bulge in the vagina is something you can see or feel.

Other signs and symptoms that may be related to prolapse are:

  • frequent voiding or the urge to pass urine
  • urinary incontinence (unwanted loss of urine)
  • not feeling relief right after voiding
  • frequent urinary tract infections
  • pain in the vagina, pelvis, lower abdomen, groin or lower back
  • heaviness or pressure in the vaginal area
  • sex that is painful
  • tissue sticking out of the vagina that may be tender and/or bleeding

Some cases of prolapse may not cause any symptoms.

Causes

Prolapse can develop for many reasons. The major cause is stress on this supportive “hammock” when giving birth. Women who have many pregnancies, deliver vaginally, or have long or difficult childbirth are at higher risk.

Other factors that can lead to prolapse are:

  • heavy lifting
  • chronic coughing (or other lung problems)
  • constipation
  • frequent straining to pass stool
  • obesity
  • menopause (when estrogen levels start to drop)
  • prior pelvic surgery
  • aging

Diagnosis

Prolapse can be found with a clinical history and a pelvic exam. The exam may be done while you are lying down, straining or pushing, or standing. Your health care provider may measure how serious the prolapse is and what parts of the vagina are falling.

Other tests and imaging studies may also be done to check the pelvic floor, such as:

  • cystoscopy
  • urodynamics
  • x-rays
  • ultrasound
  • MRI

Treatment

How is Bladder Prolapse Treated?

Conservative Management

Conservative measures involve

  1. No treatment. Some women have bladder prolapse and do not have bothersome symptoms. You do not need to treat your prolapse if it is:
    • not causing you problems
    • not blocking your urine flow

2. Behavior therapy this can include:

    • kegel exercises (which help strengthen pelvic floor muscles)
    • pelvic floor physical therapy
    • a pessary (a vaginal support device)

3. Drug therapy this includes:

    • estrogen replacement therapy
Surgery

The goal of surgery is to repair your body and improve symptoms. Surgery can be performed through the vagina or the abdomen. There are several ways the surgery can be done, they include:

  • Open surgery– when an incision (cut) is made through the abdomen
  • Minimally invasive surgery– uses small incisions (cuts) in the abdomen
  • Laparoscopic- the doctor places surgical instruments through the abdominal wall
  • Robot-assisted laparoscopic– robotic instruments are placed through the abdominal wall. They are attached to robotic arms, and are controlled by the surgeon.

Surgery also involves options of:

    • native tissue repair (using one’s own tissue and sutures)
    • augmentation with surgical material
      • biological graft

Before having surgery you should have an in-depth talk with your surgeon. You should learn about the risks, benefits, and other choices for repairing cystocele with surgery. It is important that you give informed consent. This can only be done after your doctor has answered all of your questions.

If prolapse is left untreated, over time it may stay the same or slowly get worse. In rare cases, severe prolapse can cause obstruction of the kidneys or urinary retention (inability to pass urine). This may lead to kidney damage or infection.

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