The pelvic floor consists of a group of muscles, tissues, and ligaments that make up the base of the pelvis and support the pelvic organs. Pelvic organ prolapse (pelvic floor prolapse) occurs when these muscles and ligaments are weak or damaged, causing the pelvic organs to shift and slip below their normal positions.
Although pelvic organ prolapse is defined as a shift in any pelvic organ, the type of prolapse is identified by the organ that has dropped. It may be the bladder (cystocele), rectum (rectocele), small bowel (enterocele), or uterus (uterine prolapse). Treatment for pelvic organ prolapse will depend on the type and its severity.
Non-Medical Treatments for Pelvic Organ Prolapse
Many women with mild cases of prolapse (sometimes associated with a condition called Relaxed Vaginal Outlet) can relieve their symptoms with easy-to-do exercises and a few lifestyle changes. These include:
- Kegel exercises: Kegels are useful for all types of pelvic organ prolapse and are exercises that strengthen the muscles that control urination. (You can identify these muscles by stopping urine midstream.) Patients can do three sets of ten each day: Tighten the muscles and hold for five seconds, then relax for five seconds. With regular tightening, a woman may be able to reinforce her pelvic floor to provide support for prolapsed organs.
- Weight loss: If a woman is overweight, losing some of the weight mass may decrease pressure on her pelvic floor and improve her symptoms. This lifestyle change is helpful for mild rectocele, enterocele, and uterine prolapse.
- High-fiber diet: Eating a diet high in fiber can reduce constipation, a problem that can weaken the muscles of the pelvic floor. Such dietary alterations are proposed for mild rectocele, enterocele, and uterine prolapse.
- Avoid heavy lifting: Heavy lifting can strain and weaken the pelvic floor muscles.
Medical Treatment of Pelvic Organ Prolapse
When symptoms of pelvic organ prolapse (pelvic floor prolapse) are more moderate and lifestyle changes are not effective, medical treatments are available. Examples include:
- Estrogen therapy: This treatment is most commonly recommended for the treatment of cystocele. Topical estrogen creams or pills can be used to boost estrogen levels and help strengthen the vaginal walls, which can provide more support for the bladder.
- Pessary: A vaginal pessary is a small, removable, rubber device that can be inserted into the vagina to support the organs that have prolapsed. Pessaries can be used for all types of pelvic organ prolapse, but are most often used to treat uterine prolapse and cystocele.
Surgical Treatment of Pelvic Organ Prolapse
The most common symptom of pelvic prolapse is constipation, but others include painful intercourse, bleeding from the vagina, incontinence, pelvic pressure, and pain in the groin or lower back. If symptoms are severe, or if prolapse interferes with the urinary or reproductive systems, surgery may be needed to correct the problem. Surgical treatments for pelvic prolapse include:
- Hysterectomy: This procedure removes the uterus and can be used to treat uterine prolapse. Since removal of the uterus causes infertility, this treatment is typically reserved for older women.
- Mesh repair: Vaginal mesh repair involves suturing mesh materials (typically made of polypropylene) into the pelvic floor to help support the pelvic organs. Mesh repair is commonly used for uterine prolapse and cystocele, but can also be used for the treatment of rectocele and enterocele.
- Laparoscopic reconstructive surgery: Laparoscopic reconstructive surgery of the vagina requires the surgeon to make small incisions in the abdomen in order to view the vagina and pelvic floor. Surgical equipment is inserted and used to suture the area of the vaginal wall where organ prolapse has occurred. All types of pelvic organ prolapse can be treated laparoscopically, and the method is generally effective at reducing symptoms.
- Colpocleisis: This surgery addresses all types of pelvic organ prolapse and requires closing the vagina permanently with sutures. Typically, colpocleisis is only used in elderly patients that are no longer sexually active.
- da Vinci Sacrocolpopexy: This surgery uses a da Vinci robotic surgical system to do a mesh repair.
Prognosis
For women with mild to moderate prolapse, nonsurgical treatments--such as lifestyle changes, estrogen therapy, and vaginal pessaries--can reduce pain and pressure. And surgery, though very effective, may not be able to repair all prolapsed organs. Treatment success depends on the severity of the prolapse. And in some instances, such as when surgery further injures the pelvic floor, prolapse can occur in another area.
References
Badash, M. (2012). Uterine prolapse. Conditions and Procedures in Brief, 1-3.
McCoy, K. (2012). Vaginal prolapse. Conditions and Procedures in Brief, 1-3.
