Pelvic Organ Prolapse

Pelvic organ prolapse means that the uterus and/or the vagina have fallen down from its normal position in the pelvis. This prolapse is probably caused by injuries sustained during childbirth, aging, a woman's tissue composition, chronic coughing and heavy lifting.

Types of prolapse

Cystocele is caused by a defect in the anterior vaginal wall, which allows the bladder to protrude into the vagina. If the defect is severe enough, the bladder may protrude through the vaginal opening.

Women who have a cystocele may experience pelvic pressure, involuntary loss of urine when coughing, sneezing, or lifting heavy objects, a protrusion from the vaginal opening, and an uncomfortable feeling during intercourse.

Occasionally, women with cystocele may also experience involuntary urine loss immediately after the urge to urinate, and urinary retention (inability to empty the bladder). Frequently, as the prolapse becomes more severe, the involuntary loss of urine associated with coughing, sneezing, or lifting becomes less severe because the urethra is kinked.

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Enterocele is caused by a defect high in the back of the vagina, which allows the small intestine to protrude into the vagina. If the protrusion is severe enough, it may be seen or felt outside the vagina.

Women who have enterocele often experience pelvic pressure, lower backache, a protrusion from the vaginal opening, and an uncomfortable feeling during intercourse.

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Rectocele is caused by a defect in the back of the vagina, which allows the rectum to protrude into the vagina. If the protrusion is large enough, it can be seen or felt outside the vagina.

Women who have rectocele often experience pelvic pressure, a protrusion from the vaginal opening, constipation, and an uncomfortable feeling during intercourse. This constipation frequently can be relieved by assuming a specified posture or applying pressure to the back of the vagina.

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Uterine prolapse occurs when the uterus descends into the vagina. Women with uterine prolapse often experience pelvic pressure, lower backache, a protrusion from the vaginal opening, and an uncomfortable feeling during intercourse.collapse

Vaginal vault prolapse is caused by tears in the tissue which attach the top of the vagina to the pelvic sidewall. When the top of the vagina falls down, it can cause the front and the back of the vagina to fall down as well.

In its most severe form, the entire vagina can protrude outside the vaginal opening. This complete prolapse of the vagina is known as procidentia.

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Evaluation for prolapse

The initial evaluation for pelvic organ prolapse takes approximately 30-45 minutes and involves a detailed history and physical examination. Usually, no other tests are involved. If a woman also has urinary incontinence, the evaluation may take longer.

Treatment for prolapse

Pelvic organ prolapse is rarely caused by serious underlying medical conditions such as cancer. Consequently, the choice of treatment usually depends on the severity of symptoms and how much these symptoms are interfering with the quality of life or daily activity. 

Cystocele is repaired through a vaginal incision. If the patient's own tissue is inadequate to perform a proper repair, a synthetic tissue may be put in to reinforce the repair. However, if a woman also has stress incontinence, the cystocele may have to be repaired through an abdominal incision or a combination of an abdominal and a vaginal incision.

This surgery usually requires hospitalization for 1-2 days. After discharge, the patient should refrain from strenuous or sexual activities for six weeks in order for the repair to heal properly.

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Enterocele is repaired through a vaginal or abdominal incision. This surgery usually requires hospitalization for 1-2 days. After discharge, the patient should refrain from strenuous or sexual activities for six weeks in order for the repair to heal properly.

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Rectocele is repaired through a vaginal incision. If the patient's own tissue is inadequate to perform a proper repair, a synthetic tissue may be put in to reinforce the repair.

This surgery usually requires an overnight hospital stay. After discharge, the patient should refrain from strenuous or sexual activities for six weeks in order for the repair to heal properly. She should also follow a high fiber diet and refrain from straining during bowel movements.

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Uterine prolapse is usually treated with a hysterectomy. The hysterectomy is usually performed through a vaginal incision.

A vaginal hysterectomy usually requires hospitalization for 1-2 days. After discharge, the patient should refrain from strenuous or sexual activities for six weeks in order for the incisions to heal properly.

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Vaginal vault prolapse is repaired through a vaginal or an abdominal incision. The surgery may require using a piece of synthetic tissue to reattach the dropped vagina to the bony pelvis.

The length of hospital stay after this procedure is usually 2-3 days. After discharge, the patient should refrain from strenuous or sexual activities for six weeks in order for the repair to heal properly.

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A pessary is a small latex or plastic device that is put in the vagina to prevent the vagina and/or the uterus from falling down. It can be used to treat all types of prolapse.

Pessaries come in many shapes and sizes. The most commonly used pessary looks like a donut or a diaphragm.

A properly fitted pessary does not cause any discomfort. Usually, a woman is not even aware that she is wearing a pessary. It does not restrict one's daily activities and can be used for many years without problems. If so desired, the pessary can be easily removed by the individual herself at bedtime and reinserted in the morning.

Some women with prolapse cannot retain a pessary in the vagina for various reasons.

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