Stay Acquainted With Both Laparoscopic Hysterectomy and Myomectomy

Having the ability to conceive is a boon for every woman but if the main organ for conceiving- the uterus, has to be removed due to unusual bleeding, procidentia, or uterine leiomyoma, it shatters the hope of a woman becoming a mother. Regardless of this saddening feeling, we cannot deny that all these symptoms require our immediate concern and consultation from a doctor regarding the need for a laparoscopic uterus removal through laparoscopic hysterectomy surgery.

Even though there might be a requirement for total uterus removal yet there is another procedure as well where problems related to the uterus may be treated by keeping it in place which is through a laparoscopic myomectomy surgery. Although you will be guided through both these procedures whenever you visit your consultant, still won’t it be nice to be prepared beforehand so that you can have a proper discussion with your doctor on this health problems? Thus we are here to provide you with some more knowledge about the procedures, hazards, and advantages of both these surgeries.

Laparoscopic hysterectomy – It involves the surgeons detaching the uterus from the uterine tube, gonads, and upper hymen also including the capillary and tissues connected to it before the removal of the uterus, through an indentation in the lower abdomen. This is a type of surgery that can be used to treat various gynecological problems including –

Fibroids

Adenomyosis

Cancer relating to gynecology

Procidentia

Irregular uterine bleeding

Endometriosis

Incessant pain in the pelvic area

However, to treat these syndromes there are four types of laparoscopic hysterectomy surgical procedures which are the following-

Total hysterectomy with bilateral salpingo-oophorectomy

Total hysterectomy

Radical hysterectomy with bilateral salpingo-oophorectomy

Supracervical hysterectomy

But don’t worry because which type of surgical procedure is feasible for your laparoscopic uterus removal will be surely consulted by your doctor after examining your condition. Yet like any other surgery, this surgery also has its risks or problems which might be-

Stasis of the lower bowels

Severe infection

Excessive bleeding

Scarring adverse reactions

Having an adverse reaction to the anesthetic

Injury in the renal system

Although there are certain risks to this surgery, if you are under the observation of a good specialist then all these risks can be avoided, which further leads to important benefits like avoiding the suffering from continuous pelvic pain or irregular bleeding as well as lowering the risk of cancer in the reproductive system.

Laparoscopic myomectomy- It is a procedure allowing the surgeons to eliminate uterine leiomyoma - a type of growth in the uterus consisting of conjoining tissues and myocytes, from the endometrium by retaining the oviduct in its place.

A laparoscopic myomectomy, however, also comprises three different types of myomectomy surgery –

Open myomectomy

Hysteroscopic myomectomy

Minimally invasive laparoscopic myomectomy

Standard laparoscopic myomectomy

Single port myomectomy

Despite the surgery women still possess a chance of having new or recrudescing fibroids for which there are certain non-surgical treatments -

MRI- guided focused ultrasound surgery (MRgFUS)

Uterine artery embolization(UAE)

Radiofrequency volumetric thermal ablation( RVTA)

Even though a laparoscopic myomectomy has fewer drawbacks yet those few pertaining hazards that can not be avoided are-

Blotched tissue

Severe blood loss

Complications during pregnancy

Rare chance of dissipating a malignant lump

However, to keep these risks at bay here are some strategies suggested by the specialists for you to keep in mind-

Vitamins and Iron supplements 

Medication to lessen uterine leiomyoma

Therapy-related to hormones

Apart from these risks the main two outcomes of the laparoscopic myomectomy are-

Solace from symptoms

Improvement in productivity

Nonetheless, whenever you consult your healthcare provider all these procedures will be discussed thoroughly to clear all your doubts or queries regarding laparoscopic uterus removal.

Frequently asked questions

Q. How much time does it require to recover from a Hysterectomy?

It may take four to six weeks pivoting on the type of surgery performed.

Q. I am a teenager, do I have a chance to develop uterine fibroids?

Yes, you do. Even though it usually occurs in the childbearing years, the chances of it occurring during any age is also possible.

Q. I recently had a laparoscopic myomectomy and I am very unsure of when I will be able to conceive, how long do I have to wait?

It is likely that you have to wait for 3 to 6 months before trying to conceive again as it’s important that you give sufficient time for your uterus to heal. 

UTERINE PROLAPSE - 3rd Year GNM, Midwifery and Gynecological Nursing (Definition, Causes, Stages, Sign and Symptoms, Diagnosis,Treatment and Prevention)

1. DEFINITION:

Uterine prolapse is a condition where the uterus slips from its normal position and pelvic cavity into the vagina. It happens when your tissue or muscle of the uterus becomes weak.

Complete uterine prolapse in which the uterus protrudes through the vaginal hymen is known as procidentia.

2. ETIOLOGY/CAUSE:

▪️Pregnancy / childbirth with normal or complicated vaginal delivery

▪️Weakness in the pelvic muscle due to age

▪️Weakening tissue tone due menopause

3. RISK FACTOR:

• Chronic obstructive Pulmonary Disorder (COPD)

• Obesity

• Chronic cough

• Pelvic tumors

• Straining due to Constipation

• Heavy lifting

• Using tobacco and smoking makes your lungs condition bad and due to chronic cough you may leads to uterine prolapse.

4. STAGES:

⇨First degree: The cervix drops into the vagina.

⇨Second degree: The cervix drops to the level just inside the opening of the vagina.

⇨Third degree: The cervix is outside the vagina.

⇨Fourth degree: The entire uterus is outside the vagina. This condition is also called procidentia.

5. Sign and Symptoms/ Clinical Manifestation:

Most of the people with uterine prolapse have not experience any sign or symptoms but some uterine prolapse symptoms are listed below:

• A feeling of fullness or pressure in the pelvis.

• Pain in pelvis or in the lower back.

• Pain during sex or intercourse.

• Urination problems, Pee incontinence.

• Constipation

If the situation goes to the level of procidentia then symptoms may include- bleeding, vaginal discharge, ulceration.

6. Diagnostic Evaluations:

• History collection

• Physical examination

• Vaginal examination often with a speculum

• Pelvic exam

• Urine culture

• Ultrasound

• MRI

7. MANAGEMENT:

⇒Non-surgical Management:

▪️Exercise: Pelvic Floor Muscle Training (PFMT) or Kegel exercises can help strengthen your pelvic floor muscles. This may be the only treatment needed in mild cases of uterine prolapse.

▪️Vaginal pessary: A pessary is a rubber or plastic doughnut-shaped device that fits around or under the lower part of your uterus. This device helps prop up your uterus and hold it in place.

▪️Diet and Lifestyle: Drink plenty of fluids and eat high-fiber foods, such as fruits, vegetables, beans and whole-grains to avoid constipation and avoid too much heavy lifting or do that correctly.

▪️Estrogen cream helps in restoring strength of vaginal tissue some time doctors may prescribe this cream to heal uterine prolapse.

⇒Surgical Management :

Hysterectomy - surgical removal of uterus

Prolapse repair without hysterectomy

9. PREVENTION:

Exercise regularly

Avoid becoming constipation

Take healthy diet

Maintain healthy weight

For Rectal Prolapse Treatment by Herbal Medicine contact to Daya Ayush Therapy Centre.

Visit now

http://www.prolapserectum.com/treatment.php

Urinary Prolapse - Altius Hospital

What is a prolapse uterus?

The uterus, or womb, is a muscular structure that's held in place by pelvic muscles and ligaments. If these muscles or ligaments stretch or become weak, they're no longer able to support the uterus, causing prolapse. Uterine prolapse occurs when the uterus sags or slips from its normal position and into the vagina, or birth canal.

Uterine prolapse may be incomplete or complete. An incomplete prolapse occurs when the uterus is only partly sagging into the vagina. A complete prolapse describes a situation in which the uterus falls so far down that some tissue rests outside of the vagina.

WHAT ARE THE POSSIBLE Risk factors for uterine prolapse?

The risk of having a prolapsed uterus increases as a woman ages and her estrogen levels decrease. Estrogen is the hormone that helps keep the pelvic muscles strong. Damages to pelvic muscles and tissues during pregnancy and childbirth may also lead to prolapse. Women who've had more than one vaginal birth and postmenopausal women are at the highest risk.

Any activity that puts pressure on the pelvic muscles can increase your risk of a uterine prolapse. Other factors that can increase your risk for the condition include:

Confirmed risk factors

Increasing age

Vaginal delivery

Increasing parity

Obesity

Previous hysterectomy

Possible risk factors :

Obstetric factors:

Prolonged second stage of labour.

Increased birth weight.

Pregnancy itself (as opposed to delivery factors).

Use of forceps.

Age < 25 years at first delivery.

Shape of pelvis.

Family history of prolapse.

Constipation.

Connective tissue disorders

Occupations involving heavy lifting.

What are the Vaginal/general symptoms?

Sensation of pressure, fullness or heaviness.

Sensation of a bulge/protrusion or 'something coming down'.

Seeing or feeling a bulge/protrusion.

Difficulty retaining tampons.

Spotting (in the presence of ulceration of the prolapse).

What are the Urinary symptoms?

Incontinence.

Frequency.

Urgency.

Feeling of incomplete bladder emptying.

Weak or prolonged urinary stream.

The need to reduce the prolapse manually before voiding.

The need to change position to start or complete voiding.

Is there any Coital difficulty in prolapse?

Dyspareunia.

Loss of vaginal sensation.

Vaginal flatus.

Loss of arousal.

Change in body image.

HOW IS IT GRADED?

Uterine prolapse is graded based on level of descent:

1st degree: To the upper vagina

2nd degree: To the introitus

3rd degree: Cervix is outside the introitus

4th degree (sometimes referred to as procidentia): Uterus and cervix entirely outside the introitus

Vaginal prolapse may be 2nd or 3rd degree.

What are the Types of prolapse?

Prolapse can occur in the anterior, middle, or posterior compartment of the pelvis.

What is Anterior compartment prolapsed?

Urethrocele: prolapse of the urethra into the vagina. Frequently associated with urinary stress incontinence; other symptoms are infrequent.

Cystocele: prolapse of the bladder into the vaginaa large cystocele may cause increased urinary frequency, frequent urinary infections and a pressure sensation or mass at the introitus.

Cystourethrocele: prolapse of both urethra and bladder.

WHAT ARE THE BLADDER TRAINING EXERCISES?

Bladder training, to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. The goal is to lengthen the time between trips to the toilet until you're urinating only every two to four hours.

Double voiding, to help you learn to empty your bladder more completely to avoid overflow incontinence. Double voiding means urinating, then waiting a few minutes and trying again.

Scheduled toilet trips, to urinate every two to four hours rather than waiting for the need to go.

Fluid and diet management, to regain control of your bladder. You may need to cut back on or avoid alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight or increasing physical activity also can ease the problem.

What is Middle compartment prolapse?

Uterine prolapse: descent of the uterus into the vagina.

Vaginal vault prolapse: descent of the vaginal vault post-hysterectomy. Often associated with cystocele, rectocele and enterocele.

Enterocele: herniation of the pouch of Douglas (including small intestine/omentum) into the vagina.

WHAT IS VAGINAL PROLAPSE?

Uterine prolapse is descent of the uterus toward or past the introitus. Vaginal prolapse is descent of the vagina or vaginal cuff after hysterectomy

How is uterine prolapse diagnosed?

Your doctor can diagnose uterine prolapse by evaluating your symptoms and performing a pelvic exam.

Any Conservative methods to treat prolapse?

These measures are particularly helpful for women who:

Have mild prolapse.

Want to have further pregnancies.

Are frail or elderly.

Have a high anaesthetic risk.

Do not wish to have surgery.

What are the Conservative measures available?

Watchful waiting. If a women reports little in the way of symptoms this is probably appropriate. Treatment may be needed if symptoms become troublesome or if complications develop.

Lifestyle modification: including treatment of cough, smoking cessation, constipation and overweight and obesity. However, even though the association of prolapse with these lifestyle factors has been demonstrated, the role of lifestyle modification as a prevention or treatment of prolapse is not supported by evidence.

Pelvic floor muscle exercises.

Vaginal oestrogen creams.

Oestrogen creams before surgery may reduce the incidence of postoperative cystitis

When to consider Surgery?

Failure of conservative treatment.

Presence of voiding problems or obstructed defecation.

Recurrence of prolapse after surgery.

Ulceration.

Irreducible prolapse.

The woman prefers surgical treatment.

WHAT ARE THE SURGICAL OPTIONS?

Surgical treatments include uterine hysterectomy( hysterectomy with surgical repair of the pelvic support structures (colporrhaphy) OR

suspension ( (suturing of the upper vagina to a stable structure nearby).

Surgical options include a vaginal approach (for sacrospinous ligament suspension or sacrospinous colpopexy) and an abdominal/laparoscopic approach (sacrocolpopexy).

Laparoscopic repair of prolapse has less risk of perioperative morbidity than laparotomy.

Using mesh may lower the risk of prolapse recurrence after a vaginal repair, but complications may occur more frequently. Patients should be advised that all mesh may not be removed completely so that they can make an informed decision.

How can I prevent uterine prolapse?

Uterine prolapse may not be preventable in every situation. However, you can do to things to reduce your risk, including:

Good intrapartum care, including avoiding unnecessary instrumental trauma and prolonged labour.

Hormone replacement therapy, although its role in preventing prolapse is uncertain.

Pelvic floor exercises may prevent prolapse occurring secondary to pelvic floor laxity and are strongly advised before and after childbirth.

Smoking cessation will reduce chronic cough (and therefore intra-abdominal pressure).

Weight loss if overweight or obese.

Treatment of constipation throughout life.

getting regular physical exercise

practicing Kegel exercises

What is kegels exercise?

Kegel exercises, also called pelvic floor exercises, help strengthen the muscles that support the bladder, uterus, and bowels. By strengthening these muscles, you can reduce or prevent leakage problems.

How is it done?

Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.Do it 3-4 times a day.

Is laparoscopy better option?

Laparoscopic sacrocervicopexy is an effective option for women with pelvic organ prolapse who desire uterine preservation. Laparoscopic surgery gives the added benefit of shorter hospital stay,better cosmesis,lesser postoperative pain,short recovery period .

Will the sexual functions be hampered after this surgery?

not necessarily.

what will be the time period to go back to work ?

2-3 days.

dietary restrictions if any?

to have a balanced diet

any form of exercises to be followed post-op?

Any form of physical activity say yoga,meditation,walking ,sport to keep urself fit n fine.

Will there be weight gain later?

No surgery does not make you put on weight.might be the restriction of physical inactivity self imposed can lead to weight gain.

For More data Contact Us:

Telephone: +91 8023151873 | +91 9900031842

Fax: +91 8023116750

Email: [email protected] | [email protected]

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Gynecologist in Bangalore | IVF Treatment Center in Bangalore | Uterus Removal Surgery in Bangalore

Stuff I Learned: Ten Teachers Gyne IX

Chapter 16: Urogynecology

Frequency is defined as passing urine ≥7x/day or being woken from sleep ≥ 2x/night to void

Urodynamic Stress Incontinence (USI)

Pathophysiology

For continence: urethral pressure > vesical pressure

Normally, intra-abdominal pressure should transmit to urethra and bladder equally

Abnormal descent of bladder neck and proximal urethra causes more pressure to go to bladder than urethra

Surgery/radiotherapy may cause intraurethral pressure at rest to be lower than intravesiclar pressure

Laxity of suburethral support: vaginal wall, endopelvic fascia, arcus tendineus fascia, levator ani muscles

Obstetric risk factors: prolonged second stage, large babies, instrumental deliveries, multiparity, 3-4th degree perineal tears

Menopause also causes weakness of pelvic floor

Other Causes

Overactive bladder (OAB) is a combination of urgency, frequency, and nocturia, usually neurogenic cause

Overflow Incontinence causes: urethral obstruction, drugs (anticholinergics), LMN/UMN lesions

Congenital: epispadias, bladder exstrophy (failure of mesodermal midline fusion and migration, respectively)

Fistula: obstructive labor, pelvic surgery/malignancy, radiotherapy

Uroflowmetry

Measurement of urine flow rate, bell curve shape

<15mL/second on more than one occasion is abnormal

Unreliable if voided volume <150mL

Cystometry

Normal parameters

Residual volume < 50mL

Desire to void between 150-200mL

Capacity between 400-600mL

Detrussor pressure rise < 15 during filling and standing (low compliance detrusor if > 15cm H2O)

Absent detrussor contractions (detrusor overactivity if present)

No leakage on coughing (USI if present)

Voiding detrusor rise < 70 with peak flow rate > 15mL/second

Treatment of USI

Pelvic floor exercises: pre-menopausal women respond better

Transvaginal tape (TVT) is a type of intravaginal slingplasty: replace deficient pelvic floor muscles and provide a backboard of support under the urethra

Treatment of OAB

Bladder retraining, biofeedback, hypnosis

Anticholinergic agents: oxybutynin, tolterodine

Surgical: bladder augmentation, ileal conduit, sacral nerve stimulator

Botulinum toxin injections

Chapter 17: Pelvic Organ Prolapse

Types

Anterior: urethrocele, cystocele, cystourethrocele, treat with anterior repair (colporrhaphy) but should be avoided if there is concurrent stress incontinence

Posterior: rectocele, enterocele, treat with posterior repair (colporrhaphy)

Apical vaginal: uterovaginal, vault, treat with colpocleisis, VH+PFR

3rd degree uterine prolapse is called procidentia and usually accompanied by cystourethrocele and rectocele

Sacrohysteropexy = use mesh to suspend uterus to sacrum, for uterine prolapse

Sacrocolpopexy = use mesh to suspend vagina to sacrum, for vaginal vault prolapse

Prolapsed Uterus

Western medicine- downward displacement of the uterus, usually as a result of weakening or stretching/tearing (during childbirth) of the supporting tissues. It is divided into 3 degrees of severity. Degrees: 1. cervix falls to pubis symphysis 2. can see cervix 3. uterus exits to external (procidentia) Acupuncture – moxa and needle, Du 20, Ren 4, 6, GB 28 (meeting hui of the Dai Mai), ST 36.

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from Health-Info.org https://health-info.org/acupuncture/disease-treatments/prolapsed-uterus/ from Health Info Org https://healthinfoorg.tumblr.com/post/189408748164

Prolapsed Uterus

Western medicine- downward displacement of the uterus, usually as a result of weakening or stretching/tearing (during childbirth) of the supporting tissues. It is divided into 3 degrees of severity. Degrees: 1. cervix falls to pubis symphysis 2. can see cervix 3. uterus exits to external (procidentia) Acupuncture – moxa and needle, Du 20, Ren 4, 6, GB 28 (meeting hui of the Dai Mai), ST 36.

Source

The post Prolapsed Uterus appeared first on Health-Info.org.

from Health-Info.org https://health-info.org/acupuncture/disease-treatments/prolapsed-uterus/

Pelvic Organ Prolapse

Overview

Pelvic organ prolapse (POP) occurs when one or more organs in your pelvis—your uterus, vagina, urethra, bladder or rectum—shifts downward and bulges into or even out of your vaginal canal. In the United States, 24 percent of women have some sort of POP. Just one symptom that can be associated with the condition—urinary incontinence—costs the country more than $20 billion annually in direct and indirect medical costs, while surgeries to correct POP cost more than $1 billion annually. Approximately 200,000 surgeries are done each year in the United States to correct POP. The condition is poised to become much more common in the United States and other Western countries with the aging of the Baby Boomers (women ages 45-63). In fact, an estimated 11 to 19 percent of women will undergo surgery for POP or urinary incontinence by age 80 to 85, and 30 percent of them will require an additional surgery to correct the problem. Many women don’t have any symptoms of POP. Those who do may experience a feeling of vaginal or pelvic fullness or pressure or feel as if a tampon is falling out. They may also experience incontinence, uncomfortable intercourse, pain in the pelvic area unrelated to menstruation, lower back pain and difficulty getting stools out.. Some women also complain of not being able to fully void stools and of fecal soiling of their underwear. Treatments include lifestyle options, such as exercises to strengthen the pelvic floor, devices designed to support the pelvic organs, physical therapy and surgery to repair damaged ligaments and reposition the prolapsed organs. For women not planning to have sex, obliterative surgeries, which close off the vaginal opening, are also an option. Risk factors for POP include pregnancy (particularly pregnancies that have ended with a vaginal birth, especially a forceps-assisted birth), genetic predisposition, aging,obesity, estrogen deficiency, connective tissue disorders, prior pelvic surgery and chronically increased intra-abdominal pressure from strenuous physical activity, coughing or constipation. In many cases, women with POP have at least two or more risk factors. Having been pregnant with and given birth to a child—particularly two or more children—is a significant risk factor. According to the National Association for Continence, as many as 50 percent of women who have ever given birth have some degree of POP. While cesarean section delivery reduces the risk of POP and urinary incontinence, there is still no good evidence to support elective cesarean sections for preventing POP. Having a hysterectomy may also increase your risk of POP, depending on how the surgery was performed and how well the surgeon reattached the ligaments that typically hold up the uterus to the top of the vagina, where the cervix used to be. Genetic factors also contribute to your risk of POP. If possible, talk to your mother, grandmother, aunts and sisters about any pelvic organ problems they’ve had. Also ask about urinary and fecal incontinence; although it’s embarrassing to talk about, both are often associated with POP.

Diagnosis

The most common symptoms associated with pelvic organ prolapse (POP) are related to urination. You may have feelings of urgency, in which you suddenly have to urinate, find yourself urinating more often than normal, experience urinary incontinence or have difficulty urinating and completely emptying your bladder. Some women experience painful intercourse, problems reaching orgasm and reduced sexual desire or libido. Although prolapse does not directly interfere with sexuality, it may affect self-image. Data shows that women with urge incontinence have the most problems with sexuality and that POP interferes with sexuality more than any other form of incontinence. Some women avoid sex because they are embarrassed about the changes in their pelvic anatomy, and some worry that having sex will “hurt” something or cause more damage. You may also experience problems in the rectal area. Some women with POP have pain and/or straining during bowel movements, and some experience anal incontinence, in which they inadvertently release stool. Other symptoms include feeling as if a tampon is falling out. In fact, if the cervix has descended into the vagina, you may find you can’t use a tampon at all. However, doctors may have trouble diagnosing the condition because many symptoms can be related to situations and medical conditions unrelated to POP. The following questions can help alert your doctor to the possibility that you may have POP: Do you ever have to push tissue back in the vagina to urinate? Do you have to use your fingers in the vagina, on the perineum (the area between the anus and vagina) or in the rectum to have a bowel movement? Do you ever feel a bulge or that something is “falling out” of your vagina? Or do you feel like you’re sitting on an egg? Let your doctor know if you answered yes to any of these questions. Diagnosing POP begins with a complete medical history and physical examination. The doctor will carefully examine your vulva and vagina for any lesions or ulcers and will perform an internal examination to identify any prolapsed organs. The doctor will also conduct a rectal examination to test for the resting tone and contraction of the anal muscle and to look for any abnormalities in that region. The doctor may also examine you while you’re standing (to see if gravity brings the organs down) and may ask you to strain as if you were urinating or having a bowel movement. A check of the nerves and reflexes in this area may be included. POP refers to a displacement of one of the pelvic organs (uterus, vagina, bladder or rectum). These displacements are typically graded on a scale of 0 to 4, with 0 being no prolapse and 4 being total prolapse (called procidentia). Your doctor will determine which type of prolapse you have. The different types include the following: Bladder prolapse (cystocele). In this form, the bladder falls toward the vagina, creating a bulge in the vaginal wall. Usually the urethra also prolapses with the bladder, called urethrocele. The two together are called cystourethrocele. Symptoms include stress incontinence (when you urinate a little when you sneeze, cough, jump, etc.) or problems urinating. Rectal prolapse (rectocele). In this form, the bladder falls toward the vagina, creating a bulge in the vaginal wall. Usually the urethra also prolapses with the bladder, called urethrocele. The two together are called cystourethrocele. Symptoms include stress incontinence (when you urinate a little when you sneeze, cough, jump, etc.) or problems urinating. Uterine prolapse (uterine descensus). This is a very common form of POP. It occurs when the ligaments that hold the uterus in place weaken, like a rubber band that’s been stretched too often. This causes the uterus to fall, weakening the back walls of the vagina. Vaginal vault prolapse. This form occurs when the vaginal supports weaken and the vagina drops into the vaginal canal after a hysterectomy. It may also occur when the front and back walls of the vagina separate, allowing the intestines to push against the vaginal wall in a form of prolapse called enterocele. Enterocele may occur with a uterus in place, but vaginal vault prolapse occurs only after hysterectomy when the uterus no longer supports the top of the vagina. Tests Your doctor may order several tests to confirm a diagnosis of POP. These include: Urinary tract infection screening. You pee in a cup and your urine is evaluated for the presence of bacteria. Postvoid residual urine volume test. This determines if any urine remains in your bladder after voiding. After urinating, the doctor or nurse inserts a catheter, or thin tube, into the urethra to measure any remaining urine or uses an ultrasound to identify any urine remaining in the bladder. Urodynamic testing. This test uses special sensors placed in the bladder and rectum or vagina to measure nerve and muscle response. If you have problems with bowel movements, your doctor will likely refer you to a gastroenterologist for a thorough evaluation, including a colonoscopy to rule out colon cancer, which can cause constipation and straining. You may also have pressure testing of the rectum known as manometry.

Treatment

Pelvic organ prolapse (POP) is not a dangerous medical condition. Treatment options range from doing nothing and observing your condition over time to surgery to correct the prolapse. The choice of treatment typically depends on how your POP affects your quality of life, on your overall health and on your physician’s expertise. Nonsurgical options Observation. If you’re not having symptoms, or your symptoms are not interfering with your quality of life, you should choose a wait-and-see approach. Every year, you undergo a complete examination to evaluate your POP. Just make sure you contact your health care professional if your condition changes during the year. If you have no symptoms, treatment cannot improve your quality of life and should be avoided. Addressing symptoms. Another option is to address any symptoms you have without actually “fixing” the underlying prolapse. For instance, if you’re experiencing urinary or fecal incontinence, your doctor may recommend Kegel exercises (described below) or medication. If you are constipated and straining with bowel movements, then changing your diet, adding fiber supplements or taking medications such as laxatives may help. Kegel exercises. These exercises strengthen your pelvic floor, which can help strengthen your organs in the pelvic region and may relieve pressure from prolapse. To make sure you know how to contract your pelvic floor muscles correctly, try to stop the flow of urine while you’re going to the bathroom. If you can do this, you’ve found the right muscles. But do not do the actual exercises while stopping the stream of urine or you may develop a voiding dysfunction.To do Kegel exercises, empty your bladder and sit or lie down. Contract your pelvic floor muscles for three seconds, then relax for three seconds. Repeat 10 times. Once you’ve perfected the three-second contractions, try doing the exercise for four seconds at a time and then resting for four seconds, repeating 10 times. Gradually work up to keeping your pelvic floor muscles contracted for 10 seconds at a time, relaxing for 10 seconds in between. Aim to complete a set of 10 exercises, three times a day. Pessaries. Pessaries are diaphragm-like devices placed in the vagina to support the pelvic organs. They are commonly used in women with POP to reduce the frequency and severity of symptoms, delay or avoid surgery and prevent the condition from worsening.Most pessaries are made from silicone, plastic or medical-grade rubber. Silicone is probably best, since it is nonallergenic, doesn’t absorb odors or secretions, can be repeatedly cleaned and is pliable and soft. You typically remove the pessary at bedtime and replace it in the morning, although you can arrange to remove it less often or have it removed and cleaned at your doctor’s office. Most doctors prescribe vaginal estrogen with a pessary in postmenopausal women to prevent any irritation of the vaginal walls. Surgery An estimated 11 to 19 percent of women will undergo surgery for POP or urinary incontinence by age 80 to 85. The goal of surgery for POP is to improve your symptoms by addressing the underlying cause. Surgery can be reconstructive, which corrects the prolapsed vagina while maintaining or improving sexual function and relieving symptoms, or obliterative, which moves the organs back into the pelvis and partially or totally closes the vaginal canal. Surgery may involve repairs to any pelvic organs, including the various parts of the vagina, the perineum (the region between your vagina and anus), bladder neck and anal sphincter (anus). The goal of surgery is to reposition the prolapsed organs and secure them to the surrounding tissues and ligaments. Sometimes synthetic mesh is used to hold the organs in place. Although hysterectomy is still commonly performed in women with symptomatic POP, several other surgical procedures are available. Which your doctor recommends depends on your condition and the specific type of prolapse. Surgeries can be performed through an abdominal incision, vaginally or laparoscopically, with or without robotic assistance, through small incisions in your belly. Studies find that the vaginal or laparoscopic approach results in fewer wound complications, less postoperative pain and shorter hospital stays than with open abdominal surgery. Today, a large number of POP surgeries are performed vaginally, laparoscopically or robotically. However, all forms carry a risk of relapse. In terms of the surgery itself, procedures vary depending on the type of prolapse. In most cases, surgery for POP is performed under general or regional anesthesia (epidural or spinal), and patients may stay in the hospital overnight. Here’s an overview of the surgical procedures used to treat the various forms of POP: Rectal prolapse (rectocele). Surgery to repair a rectocele, or prolapse of the rectum, is performed through the vagina. The surgeon makes an incision in the wall of the vagina and secures the rectovaginal septum, the tissue between the rectum and the vagina, in its proper position using the patient’s connective tissue. The opening of the vagina is tailored to the appropriate dimension, and extra support is reinforced between the anal opening and the vaginal opening. Bladder prolapse (cystocele). Surgery to correct bladder prolapse, or cystocele, is usually performed through the vagina. The surgeon makes an incision in the vaginal wall and pushes the bladder up. He or she then uses the connective tissue between the bladder and the vagina to secure the bladder in its proper place. If urinary incontinence is also a factor, the surgeon may support the urethra with a sling made out of a special nylon like material. Prolapse of the uterus (uterine descensus).In postmenopausal women or women who do not want more children, prolapse of the uterus is often corrected with a hysterectomy. In women who want more children, a procedure called uterine suspension may be an option. Some doctors now use laparoscopic surgery or vaginal surgery to repair the ligaments supporting the uterus so that hysterectomy is not necessary. This operation requires only a short hospital stay, has a quicker recovery time and involves less risk than a hysterectomy. The long-term results, however, are still being studied, so talk to your health care professional about what’s right for you. If you have heavy bleeding or other uterine problems, you may want to consider hysterectomy, but if there are no other problems than prolapse, the ligament repair may be preferable. Generally, surgery for prolapse is not recommended until after you have completed childbearing because pregnancy can make it worse. Vaginal vault prolapse and herniated small bowel (Enterocele). Vaginal vault prolapse and herniated small bowel often occur high in the vagina, so surgery to correct the problems may be done through the vagina or the abdomen. There are a number of surgical procedures used to treat these forms of POP. The most common involves vaginal vault suspension, in which the surgeon attaches the vagina to the sacrum. This can be done through an incision in the abdomen, by laparoscopy (belly button surgery) or via robotic surgery. Robotic surgery takes many hours but accomplishes the surgery without a big incision. In the past, these surgeries have sometimes involved the placement of nylon mesh to suspend the vagina.However, in July 2011, the FDA issued a warning concerning the use of vaginally placed mesh to repair POP, stating that the surgical vaginal placement of mesh may expose patients to greater risk than other surgical methods including the abdominal placement of mesh, and that there is no evidence that surgeries involving mesh lead to better outcomes. Be sure to talk with your health care professional about the best approach for you.

Prevention

Preventing pelvic organ prolapse (POP) begins in your teens. Get in the habit of practicing Kegels or pelvic tilts as done in yoga several times a day, until doing them becomes as routine as brushing your teeth. When you get pregnant, make sure you’re aware of the risks and benefits of a forceps delivery in case one is necessary. A forceps delivery creates a very high risk for incontinence and prolapse. Talk to your health care professional about the options of a vacuum delivery or a cesarean section. Maintaining a healthy weight and quitting smoking may also help prevent pelvic floor problems, including POP. You should also avoid straining during bowel movements and when lifting heavy items, and if you have a chronic cough, get it checked out. Chronic coughing creates the kind of straining that can lead to POP.

Facts to Know

Pelvic organ prolapse (POP) occurs when one or more organs in your pelvis—your uterus, urethra, bladder urethra bladder or rectum—shifts downward and bulges into your vagina. In the United States, about 24 percent of women have some for of POP. Pelvic organ prolapse is poised to become much more common in the United States and other Western countries with the aging of the Baby Boomers. Symptoms of POP include a feeling of pelvic fullness or pressure; feeling as if a tampon were falling out; incontinence; uncomfortable intercourse; pelvic pain (not menstrually related); lower back pain; and difficulty getting stools out. However, many women don’t have any symptoms. Causes of POP include pregnancy, childbirth, aging, obesity and menopause. Straining with bowel movements, lifting heavy items and chronic cough can also contribute to POP. In some cases, hysterectomy can increase the risk, while a cesarean section may reduce it. The condition also has a genetic component. Urinary symptoms are the most common symptoms associated with POP. These include feelings of urgency, frequent urination, urinary incontinence or difficulty urinating. Diagnosing POP begins with a complete medical history and physical examination, including an internal exam and an anal examination. Tests to evaluate the health of your urinary system and bladder may be performed. There are four stages of POP, ranging from 0 (no prolapse) to 4 (total prolapse). There are several types of POP, including bladder prolapse, or cystocele; rectal prolapse, or rectocele; uterine prolapse, or uterine descensus; and vaginal vault prolapse. Treatment for POP depends on the type of prolapse. Treatment options range from doing nothing and observing your condition over time to surgery to correct the prolapse. Kegel exercises help strengthen your pelvic floor and may relieve pressure from prolapse. They are an excellent way to treat and prevent POP.

Key Q&A

If I have stress incontinence, does that mean I have pelvic organ prolapse (POP)?No, you can have stress incontinence without having POP. However, stress incontinence is usually related to some weakness in the pelvic floor. It often occurs in conjunction with POP. My doctor says I have some bladder prolapse, but I don’t have any symptoms. How is that possible?Pelvic organ prolapse can be mild to severe and often doesn’t have any symptoms. If you don’t have any symptoms, you don’t have to do anything if you don’t want to, although incorporating pelvic floor exercises into your daily routine to strengthen your pelvic region is a good idea. I’ve been diagnosed with POP. Do I need surgery?That depends on your personal condition. If you don’t have any symptoms and your condition is manageable with lifestyle changes, then you don’t need surgery. Surgery is not foolproof; the prolapse could recur. So try to avoid surgery until your activities of daily living are affected. If you are scheduling your life around your prolapse symptoms, it is time to address them. I’m not sure if I’m doing Kegel exercises properly. How can I tell?A physical therapist or biofeedback expert is your best option when it comes to ensuring that you’re doing Kegels properly. Physical therapists can give you vaginal cones that you place in your vagina. The squeezing pressure you use to keep the cone in the vagina teaches you which muscles to use for Kegels. Biofeedback can also be used to teach you which muscles to exercise. Talk to your health care practitioner about a referral to a physical therapist or a nurse practitioner with this expertise. There also are electrical stimulators that can help to identify and contract the correct muscles. I think I might have vaginal prolapse. Which doctor should I see?While your gynecologist can most likely manage your condition, you might also consider seeing a urogynecologist, a gynecologist who specializes in the care of women with pelvic floor dysfunction. What is the best type of surgery for POP?Again, that depends on the type of prolapse you have and your surgeon’s comfort level with various surgical techniques. Is there any way to prevent POP?Maintaining a healthy weight is important, since there is evidence that being overweight significantly increases your risk of POP. Also, straining when you go to the bathroom, lifting heavy items and chronic cough can contribute to POP. What are the risks involved in not repairing POP?Generally, none. POP won’t shorten your life or lead to other health conditions. In some situations, the prolapsed organs can irritate the vaginal wall, creating ulcers. The greatest risk is that it creates genital, urinary and rectal problems that significantly affect your quality of life. The only emergency situation is if the uterus descends to such a degree that the bladder cannot empty and acute urinary retention occurs. This is rare but requires immediate medical attention.

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