Pelvic Organ Prolapse Problems
What Is Pelvic Organ Prolapse (POP)?
A woman’s pelvic organs, including the uterus, bladder and rectum, can slip and create a bulge in the vagina after the muscles, tissues and ligaments supporting those organs weaken. Causes include: childbirth, hysterectomy, menopause, heavy lifting chronic coughing, constipation, obesity, previous pelvic surgery, neurological conditions or injuries
Pelvic organ prolapse affects one or several different organs and are classified as follows:
• Cystocele – also known as bladder prolapse, is one of the most common types of pelvic organ prolapse. A bulge or dropping of the anterior vaginal wall causes the bladder to slip into the bulge
• Urethrocele – the female urethra slips in the vagina
• Uterine prolapse – the uterus slips in the vagina
• Vaginal prolapse – the vaginal walls begin to drop and cause vagina to turn inside out
• Vaginal vault prolapse – the vagina’s upper portion slips in the vaginal canal or outside the vagina
• Rectal prolapse – the rectum turns inside out and protrudes through the anus
• Enterocele – the small intestines bulge between the uterus and rectum or bulge on the top of the vagina
• Rectocele – the rectum bulges into the posterior vaginal wall
Types of reconstructive surgery include the following:
• Fixation or suspension using your own tissues (uterosacral ligament suspension and sacrospinous fixation)—Also called “native tissue repair,” this is used to treat uterine or vaginal vault prolapse. It is performed through the vagina. The prolapsed part is attached with stitches to a ligament or to a muscle in the pelvis. A procedure to prevent urinary incontinence may be done at the same time.
• Colporrhaphy—Used to treat prolapse of the anterior (front) wall of the vagina and prolapse of the posterior (back) wall of the vagina. This type of surgery is performed through the vagina. Stitches are used to strengthen the vagina so that it once again supports the bladder or the rectum.
• Sacrocolpopexy—Used to treat vaginal vault prolapse and enterocele. It can be done with an abdominal incision or with laparoscopy. Surgical mesh is attached to the front and back walls of the vagina and then to the sacrum (tail bone). This lifts the vagina back into place.
• Sacrohysteropexy—Used to treat uterine prolapse when a woman does not want a hysterectomy. Surgical mesh is attached to the cervix and then to the sacrum, lifting the uterus back into place.
• Surgery using vaginally placed mesh—Used to treat all types of prolapse. Can be used in women whose own tissues are not strong enough for native tissue repair. Vaginally placed mesh has a significant risk of severe complications, including mesh erosion, pain, infection, and bladder or bowel injury. This type of surgery should be reserved for women in whom the benefits may justify the risks.
• A bulge outside the vagina
• Urination difficulty or frequent need to urinate
• Constipation or difficulty having a bowel movement
• Sensation of something falling out of the vagina
• Stress Urinary Incontinence
• Discomfort or pain in the vagina, pelvis, groin or lower abdomen or back
• Tender or bleeding tissue protruding from the vagina
• Painful intercourse
The FDA has issued multiple warnings about mesh used in pelvic organ prolapse procedures and most mesh products have been taken off the market.
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