Treatments for Pelvic Prolapse Offer Women Hope

Once rarely discussed or recognized, pelvic prolapse or pelvic floor weakness has now become a priority in women’s health. The problem is so prevalent that by age 80, more than one in every 10 women will have undergone surgery for prolapse.

Today, many primary care physicians and gynecologists routinely screen patients for the symptoms, but urologists are the true experts in treating prolapse conditions and the urinary incontinence that often results.

Women with mild prolapse discovered during a routine pelvic exam may have no symptoms at all. But others experience considerable discomfort and a range of symptoms, including:

• Pressure and pain. The most common complaints are a feeling of pelvic pressure, or bearing down, leg fatigue and low back pain.
• Urinary symptoms. Cystocele (bladder) and uterine prolapse can cause stress incontinence and difficulty in starting to urinate.
• Bowel symptoms. A rectocele (rectum prolapse) may cause problems with defecation by forming a pocket just above the anal sphincter. Stool can become trapped, causing pain, pressure and constipation.
• Sexual problems. A prolapse can cause irritated vaginal tissues or pain during intercourse, as well as psychological stress.

If you think you have a pelvic prolapse condition, a traditional pelvic examination is the only way to diagnose it.

Treating Pelvic Prolapse

Women with very mild symptoms may not need treatment, although they should avoid anything that might worsen the prolapse. It is often a good idea to lose weight if necessary, avoid lifting heavy objects, and quit smoking to prevent prolapses from progressing. Prolapse doesn’t necessarily worsen over time, so there’s no need to seek aggressive treatments, unless symptoms get worse.

Nonsurgical treatments include:

• Activity modification: The physician may recommend activity modification such as avoiding heavy lifting or straining.
• Pessary: This is a small plastic or silicone medical device similar to a diaphragm or cervical cap that’s inserted in the vagina to help support the pelvic area.
• Kegel exercises: Simple strengthening exercises that can tighten the muscles of the pelvic floor.
• Estrogen replacement therapy. Estrogen helps strengthen and maintain muscles in the vagina.

Practicing Kegel exercises help to strengthen the pelvic floor and reduce the chance that mild condition will progress. Kegel exercises are a series of contractions that strengthen the pelvic floor. You squeeze two sets of pelvic floor muscles at the same time: those you would use to prevent yourself from passing gas and those you would tighten to stop urinating.

Surgical options:

For women who are experiencing major discomfort or inconvenience, surgery is the only definitive way to relieve symptoms and improve quality of life.

• Vaginal surgery with mesh: The physician uses a mesh “kit to pull the vagina up to the sacrospinous ligament (near the sacrum, the triangular bone just above the tailbone). The FDA recently warned that mesh could introduce risks that are not present in traditional non-mesh surgery, including: mesh erosion (exposure of the mesh in the vagina); mesh contracture (shrinkage); pelvic pain; pain with intercourse; bleeding; and infection.
• Robotic surgery using mesh (sacrocolpopexy): For treatment of prolapse for women who have had a hysterectomy. In the procedure, the surgeon connects the prolapsed vagina to the sacrum (the triangular bone just above the tailbone) using an artificial tissue material called a mesh. The Urology Group uses the da Vinci Surgical System for these procedures, which is similar to laparoscopy with small incisions, but with the more precise movements of the robot. Considered the “gold standard” for prolapse surgery, this procedure can only be done in women who have had a hysterectomy or it can be done in conjunction with a hysterectomy. The FDA warning about mesh does not apply to this procedure.

Vaginal surgery without mesh: This treatment involves repair with either a suture or with biological material, such as pigskin. However, the repair may not have the longevity of robotic sacrocolpopexy.