Pelvic Organ Prolapse is a condition that results when the tissue of the vagina weakens, allowing one of the pelvic organs to “fall into” the vagina. A cystocele is a weakness in the front wall of the vagina causing the bladder to fall into the vagina. A rectocele is a weakness in the back wall of the vagina causing the rectum to fall in to the vagina.An Enterocele and vault prolapse is caused from a weakness in the top of the vagina causing the small intestine and the top of the vagina to fall.
Prolapse is either the result of damage to the vagina during vaginal delivery, chronic coughing or constipation, or chronic lifting. The incidence of prolapse increases with increasing age. Treatment of prolapse involves a pessary, or pelvic organ prolapse surgery.
TREATMENT OF PELVIC ORGAN PROLAPSE:
Pessary is a common treatment of prolapse. It is a latex ring or diaphragm placed by the patient into her vagina to support the prolapsing organ.
A Pessary if fit in the office, and the patient taught to change and clean their pessary every week. Pessaries can be left in place for up to 3 months.
SURGERY FOR PELVIC ORGAN PROLAPSE:
Cystocele repair is done for a prolapsing bladder, or cystocele, a Rectocele repair is offered to treat rectoceles ,, and enterocele repair done for enteroceles. Typically, these repairs are done through a vaginal incision and as an outpatient surgery. Vaginal mesh is typically not necessary, although some patients with recurrent prolapse may need a biologic graft to prevent recurrence. Most first time repairs are suture based, using only suture that dissolves to close the defect in the vagina. Pain from surgery is mild, and most patient need little pain medicine after surgery.
Vault prolapse surgery: Some prolapse that is either recurrent, or involves vaginal vault, or top of the vagina, may need to be treated with an abdominal procedure. These procedures either involve suture repair, (robotic uterosacral vault suspension) or mesh (Sacrocolpopexy). The uterosacral vault suspension can be done vaginally at the time of a hysterectomy, or abdominally using a minimally invasive approach called Robotic Assisted Laparoscopic. The choice of surgery is made by the physician as well as patient preference.