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and Reconstructive Surgery Fellowship Program in the nation!

Urogynecology Associates, PC

 

Douglass S. Hale, MD, F.A.C.O.G, FACS     |     Michael H. Heit, MD, PhD, FACOG, FACS

Pelvic Organ Prolapse Treatment

 

Pelvic organ prolapse refers to any descent or dropping of the vaginal walls and surrounding pelvic organs.  Patients may notice a “bulge” coming through the vaginal opening or feel symptoms of pressure, particularly when standing or bearing down.  A simple test to see if prolapse is responsible for your symptoms is to rate your symptoms when you first awaken and then compare them to your symptoms at the end of the day after having been up and active.   In general, prolapse will not cause discomfort when lying down as the prolapse goes back in place.  Therefore, pain that is present while lying down is rarely due to prolapse and usually has other problems that are responsible for it.

Some patients feel the prolapse as it begins to descend past the vaginal opening and can see it with a mirror.  You should make sure that what your physician sees at the time of your exam is what you have seen or felt.  As discussed in other areas, prolapse is generally classified according to the organ or organs that are dropping.  The term cystocele is used to describe dropping of the bladder; uterine or vaginal prolapse refers to dropping of the uterus of top of the vagina; enterocele is descent of the small bowel; rectocele is pushing out of the rectum through the back vaginal wall.  There are other organs that can be involved as well, but these are rarer.  As per the treatment ladder, prolapse can be treated with conservative management , pessary use or surgery.

Conservative Management of Pelvic Organ Prolapse

Strengthening the pelvic floor muscles is the first step in treating pelvic organ prolapse.  The “Kegel” muscles need to gain strength and more importantly coordinate with your abdominal wall muscles.  Picture a balloon that is squeezed.  It will bulge out.  When your abdominal wall muscles contract, it is like the “balloon” getting squeezed.  The force is transmitted to your pelvic floor muscles and the organs and vaginal walls can slowly be pushed out over time just like the balloon.  A physical therapist specially trained to treat these muscles can help you learn to coordinate the pelvic floor muscles to contract whenever the abdominal wall muscles are pushing the organs down.  Any activities that lead to contraction of the abdominal muscles such as lifting, exercising, standing from a seated position, bending, coughing, or many others can lead to  pushing out of the pelvic organs.  By learning to contract the pelvic floor muscles at the same time, the organs will be “held” in place.  This is a very important concept with patients that have prolapse and needs to addressed for the best outcomes.

Pessary Management of Pelvic Organ Prolapse

A pessary is a device inserted vaginally that can help hold up the dropping pelvic organs.  It will be fitted for you and then ideally you will be able to insert and remove the pessary with proper instruction.  Not everyone can wear a pessary and you will not know whether it can work for you until you try.  For many patients this is an excellent, non-surgical way to treat prolapsing organs.  Estrogen cream or a lubricant can help with using the pessary and this will be discussed with you.  If you are able to remove and place the pessary after being shown how, you will be asked to do this on a daily basis.  The pessary is removed at night when you go to bed and reinserted in the morning.  This lets the vaginal tissue have a “rest” period each day.  Different regiments can be discussed to be more convenient for you individual case.  Pessaries are generally made from silicone or latex and come in many different sizes and shapes.  The particular pessary that is right for you will be determined at the time of your pessary fitting.  Pessaries are very low risk and many patients initially reluctant to try a pessary are pleasantly surprised with them after proper instruction.   Examples are shown below.

More Examples of Pessaries

Many different types of surgeries exist to treat pelvic organ prolapse.  The most commonly used surgeries in the United States were first described over 100 years ago.  Newer surgeries evolve each year but long-term data on the most recently developed surgeries is not yet available. In general, surgery for pelvic organ prolapse my be performed vaginally, abdominally, or laparoscopically.  We have extensive experience with all these routes and can help you choose the most appropriate for your case.

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 Urogynecology Associates, PC

1633 North Capitol Avenue. | Indianapolis, IN  46202 | Phone: 317.962.6600 | Fax: 317.962.2049