Pelvic Floor Repair & Pelvic Organ Prolapse
Pelvic Organ Prolapse occurs when the muscles that hold the internal pelvic organs become weak. This is like a hernia of pelvic floor muscles. This allows one or more organs to prolapse into the vagina. These organs can be uterus, vagina, bowel and bladder. Prolapse can occur if there is a weakness in the muscle or the ligaments become too stretched and tear away.
Causes of Prolapse:
- Pregnancy and child birth
- Aging and menopause
- Obesity
- Chronic cough & constipation, weight gain, heavy lifting, smoking & straining
- Inherited weakness of the pelvic floor is also a factor
There are 3 different types of prolapse:
- Prolapse of the front wall of the vagina is also call Cysto urethrocele or Cystocele which allows the prolapse of the bladder and/or urethra to occur from the vagina in the front of the canal and a bulge can be felt.
- Prolapse of the back wall of the vagina could be rectocele when the rectum bulges against the back wall of the vagina or enterocele when part of small intestine slips between the back wall of the vagina and the rectum.
- Prolapse of the uterus occurs when the uterus drops into the vaginal canal. It is the second most common type of prolapse after the bladder prolapse.
The degree of the prolapse can be divided into 4 grades:
- Grade 1 – When the prolapse is in the lower half of the vagina
- Grade 2 – When the prolapse is in the third of the vagina
- Grade 3 – When the vagina, uterus and cervix are protruding partially
- Grade 4 – When the vagina, uterus and cervix are protruding completely
Women who have had a hysterectomy can also develop a prolapse of vaginal vault which is a the top of the vagina. Symptoms of pelvic organ prolapse are:
- Dragging sensation which is worse towards the end of the day or after prolonged standing.
- Repeated urinary infection, dribbling, poor stream and incomplete emptying.
- Difficulty in emptying the bowels.
- Difficulty in sexual intercourse.
- Vaginal dryness or pain
- Lump
Surgical of the treatment are to restore the normal anatomy. After pelvic floor exercises, either through:
- Magnetic chair exercise program – neotonus chair program can be performed
- Or Physiotherapist
- Urodynamics study may be recommended even if you have no urinary symptoms as prolapse can sometimes mask the symptoms of stress incontinence therefore an operation to improve the prolapse may expose incontinence
Surgery may include treatment of prolapse via the vagina or through the abdominal wall. Some techniques may require the use of strong mesh which can be biological or synthetic which is stitched into the fascia to reinforce it.
Recovery depends on many factors including your age, health and type of operation. Most of the women will have a catheter in the bladder to drain it which is removed within 24 hours after surgery depending upon the type of surgery. After general anaesthetic you will be given deep breathing exercises to keep the lungs clear and also to reduce the risk of blood clot you will be encouraged to walk around soon after the surgery. To help you recover from the surgery, you should not do heavy pushing, pulling or lifting for at least 6 weeks. Avoid straining and lifting afterwards. No vigorous exercises for at least 6 weeks. Follow your Doctors advice on driving and returning to work. Be careful as pain medication can also cause temporary changes in the bowel habits.
For further information about Pelvic Floor Repair & Pelvic Organ Prolapse, please contact Dr. Singla's office.