Prolapse

Treatment available for rarely discussed condition affecting 14 million U.S. Women

Dr. Jeffrey Hantes offers long-term solutions to treat pelvic organ prolapse, a condition in which pelvic structures like the bladder or rectum bulge or protrude into the vaginal wall. Despite the fact that as many as 14 million women in the U.S. are affected by pelvic organ prolapse (POP), most women are not familiar with the condition.

“There is a silence around pelvic organ prolapse,” explains Dr. Hantes of Female Health Associates of North Texas. “Because of the intensely personal nature of the condition, women suffering from it often do not share the information and so there’s not an ongoing dialogue that educates other women. It is important to know that effective solutions are available and women do not have to live with this health issue.”

Pelvic organ prolapse is caused by muscles and ligaments that have been weakened or damaged. More than one pelvic organ can prolapse at the same time. Organs that can be involved in POP include the bladder, the uterus, the rectum, the top of the vagina (vaginal apex) after a hysterectomy, and the bowel.

The most common causes of POP include: childbirth, previous surgery, hysterectomy, obesity, age, ethnicity and genetics. Women who experience repetitive straining, such as with chronic constipation, or with jobs that involve heavy lifting, may be at an increased risk for vaginal prolapse. In addition, menopause may also be a factor in the onset of prolapse.

How Do I Know If I Have Pelvic Organ Prolapse?

Symptoms common to pelvic organ prolapse include:

• A bulge or lump in the vagina
• The vagina protruding from the body
• A pulling or stretching feeling in the groin area
• Difficult or painful sexual intercourse
• Vaginal pain, pressure, irritation, bleeding or spotting
• Urinary and fecal incontinence
• Difficulty with bowel movements
• Delayed or slow urinary stream

Vaginal vault prolapse is more common in women who have had a hysterectomy and occurs when the uppermost part of the vagina—called the apex—descends into the vaginal canal because it does not have the same support that was there when the uterus was present. As a result, the apex pulls the rest of the vagina down into the vaginal canal or even outside the vagina.

“The pain and discomfort with prolapse can be significant,” says Dr. Hantes. “Often, women will refrain from sexual intercourse because of discomfort, limit physical activity and even be faced with urinary or fecal incontinence.”

Vaginal vault prolapse can occur alone or along with a cystocele (dropping of the bladder into the vagina); urethrocele (sagging of the urethra into the vagina); rectocele (pushing the rectum into the vaginal wall); or enterocele (bulging of the small intestine into the vaginal wall).

Your Body Before & After Prolapse

Healthy pelvic area before prolapse

The bladder, vagina, and rectum are normally well supported by pelvic muscles and ligaments

Vaginal Prolapse (VP)

Vaginal prolapse occurs when weakened muscles or ligaments allow the pelvic organs to descend into the vaginal wall, causing discomfort and other symptoms.

Click here to learn more about the different types of Vaginal Prolapse

Treatment options for prolapse may very depending on the type of prolapse. The treatment chosen will depend on the severity of the condition as well as the woman’s general health, age, and desire to have children. Some of the non-surgical options include Kegel exercises, a vaginal pessary and/or estrogen replacement therapy.

Surgery for prolapse has made considerable strides in recent years and physicians now offer a number of minimally invasive, long-term surgical solutions. Surgical correction can by performed using a transvaginal approach, with laparoscopic surgery and/or both. Many physicians use a mesh—either synthetic or biologic, to restore pelvic structures to a more normal anatomical position and reinforce the structures around the vagina to maintain support.

“Mesh is soft and has large pores designed to allow your body tissue to grow into it, providing a framework of support,” explains Dr. Hantes. “The use of surgical mesh is not new. It has been used in surgery for many years.”

As with any surgical procedure, the incorporation of mesh into surgical repair has its risks and benefits. Mesh may improve long term anatomic results of surgery as compared to non-mesh repairs for some types of prolapse but is also associated with risks to the patient including vaginal extrusion, erosion, sexual dysfunction, pain and other complications. However, it is important to recognize that many of these complications are not unique to mesh surgeries and are known to occur with non mesh procedures as well.

“If you are a woman suffering from POP, it is imperative that you find a doctor who has been rigorously trained in the principles of female pelvic anatomy and pelvic reconstructive surgery,” says Dr. Hantes, who has been using mesh during vaginal surgery for many years with excellent results. Dr. Hantes further states, “I strive to meet the needs of my patients with evidence-based solutions and will continue to deliver the most appropriate care based on each individual case.”

Living with prolapse can be a challenge, both physically and emotionally, as the symptoms can disrupt day to day life and it is important for women to know that there are treatment options available. For more information on pelvic organ prolapse, contact Female Health Associates of North Texas at 817-731-3936.