Copyright 2010. All rights reserved. Last Modified - 12/17/2010
Pelvic Organ Prolapse
Pelvic Organ Prolapse
Pelvic organ prolapse refers to the descent or herniation of pelvic organs such as the bladder, uterus, and the small or large bowel into, and sometimes out the vaginal canal. Prolapse development can be attributed to several factors, including vaginal childbirth, advancing age, genetic predisposition and previous pelvic surgery.
Three types of pelvic organ prolapse can occur.
Protrusion involving the anterior wall of the vagina and bladder is called a cystocele or “dropped bladder”
Protrusion involving the posterior wall of the vagina and rectum is called a rectocele
Apical protrusion, or involvement of the upper portion of the vaginal wall and small bowel is called an enterocele
Figure A: corresponds to the normal anatomical relationships of the female pelvic organs. Figure B: shows a cystocele Figure C: depicts a rectocele Figure D: depicts an enterocele
What are the symptoms of Pelvic organ prolapse?
There are numerous complaints attributed to the various types of prolapse
Cystocele: The most common complaints are a feeling of pressure in the pelvis, tissue protruding from the vagina, loss of the ability to empty the bladder to completion, frequent urinary tract infections, pain with intercourse (dyspareunia), and vaginal pain.
Rectocele: The most common complaints are pelvic pressure, tissue protrusion from the vagina, pain with intercourse, the inability to empty the bowels, discomfort with physical activities, or the need to manually reduce the prolapse in order to defecate.
Enterocele: This form of prolapse can present with symptoms similar to a cystocele or rectocele, and often occurs in conjunction with them. Enteroceles are most common in women after hysterectomy or other pelvic surgery.
There are both surgical as well as conservative approaches to manage all types of prolapse, and a detailed treatment plan can be discussed with you and agreed upon at the time of consultation.
What does surgery entail?
Prolapse surgery involves repositioning the affected organ or organs and reconstructing the vagina to a more normal appearance and orientation. This is most commonly performed via the vagina without abdominal incisions or scars. However should you require a more extensive repair, we are very experienced in open abdominal, laparoscopic and robot assisted techniques as well. Depending on the severity of prolapse, many of these procedures can be performed as an outpatient or with one night in the hospital or ambulatory surgery center. Many times your tissue is weak and stretched so we need to use additional materials to help support the repair. The materials we may use are either your own tissue (fascia), cadaveric tissues, porcine tissues (pig) or synthetic tissues (polypropylene mesh). Your surgeon will discuss if any tissue or mesh is needed and which one is best suited for you.
In October, 2008, the FDA issued a Public Health Notification regarding the use of synthetic meshes within the vagina for either pelvic organ prolapse or for stress urinary incontinence. El Camino Urology Medical Group encourages you to read this important patient safety document and address any concerns prior to scheduling surgery. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm061976.htm
Prior to surgery
You may be asked to see your family physician for a preoperative check up. If necessary, they will do an EKG, blood work, chest X-ray, and urine tests. We do not require routine blood donation before surgery
DO NOT TAKE ASPIRIN, BLOOD THINNING MEDICATIONS, VITAMINS AND HERBAL SUPPLEMENTS FOR 1 WEEK PRIOR TO SURGERY. This includes Coumadin, Heparin, Motrin®; Advil®, ibuprofen, Aleve®; glucosamine; vitamins A, C, D, and E; garlic; Echinacea; and omega-3 fatty acids. If necessary you can safely take Tylenol® for headaches or pain. Any other medication such as antibiotics, high blood pressure pills, and heart medications should be continued unless otherwise specified. Please discuss any concerns about stopping these medications with your family doctor.
DIABETICS: If you take NPH insulin, you should take ½ the regular dose the night before surgery but DO NOT take any NPH the morning of surgery.
DO NOT EAT OR DRINK ANYTHING AFTER 12 MIDNIGHT THE DAY BEFORE SURGERY. Any medications that must be taken the morning of surgery should be taken with a small sip of water.
BOWEL PREP/CLEAR DIET: Your surgeon may ask you to take a bowel prep the night before your surgery. If so, take one bottle of Magnesium Citrate (over the counter at most drug stores) in the early afternoon the day before your surgery. Then consume only clear liquids that evening. Clear liquids are food products you can see through such as broth and juices and Jell-O®. These foods help to keep the bowel clean at the time of surgery and reduce the risks of contamination.
What are the risks and complications of prolapse surgery?
Complications from theses procedures are not common, but may occur. The major risks include: bleeding and infection, accidental injury to the bladder, bowel, ureters(drainage tubes from the kidneys to the bladder) or other nearby structures requiring open repair, pain, inability to urinate (urinary retention), recurrent or worsening incontinence, new or worse vaginal prolapse, urgency or urge-type incontinence, narrowing of the vagina, or pain with sexual intercourse.
What happens after surgery?
Following surgery, your vagina will be packed for a short time with a gauze roll in order to minimize bleeding. You will have a catheter exiting the urethra for a similar period of time. It will drain from the bladder and fill into a bag. The catheter has a balloon on it to prevent it from falling out. Most patients will be able to void spontaneously following surgery however if you are unable to, you will be sent home with the catheter for 3-5 days. The catheters are in place to allow you to empty your bladder, as there is often swelling after surgery that prevents one from being able to urinate. After the swelling subsides, you will gradually be able to urinate. Your normal pattern may not return for a few weeks, but this is normal, and not cause for alarm.
Please click to download post-operative instructions for pelvic organ prolapse surgery