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Pelvic Organ Prolapse
- Downward descent of female pelvic organs including the bladder, uterus and the small/large bowel, resulting in protrusion of the vagina, uterus or both
- 4 Main Types:
- Cystocele/Dropped Bladder: Protrusion involves the front (posterior wall) of the vagina and rectum (Most common type)
- Rectocele: Involves the back (posterior wall) of the vagina and rectum
- Enterocele: Involves the upper portion of the vaginal wall and small bowel
- Uterine Prolapse: When the uterus descends downwards
- Anything that puts increased pressure in the abdomen
- Pregnancy, labour and childbirth
- Obesity
- Constipation
- Pelvic organ cancers
- Hysterectomy
- Genetics
- Connective tissue disorders
- Selective estrogen-receptor modulators
- Advancing age
- Vaginal
- Sensation of a bulge/protrusion
- Seeing or feeling a bulge/protrusion
- Pressure
- Heaviness
- Urinary
- Incontinence
- Urgency
- Frequency
- Weak/prolonged urinary stream
- Hesitancy
- Feeling of incomplete emptying
- Manual reduction of prolapse to start/complete voiding
- Position change to start/complete voiding
- Bowel
- Incontinence of flatus, or liquid or solid stool
- Feeling of incomplete emptying
- Straining during defecation
- Urgency to defecate
- Digital evacuation to complete defecation
- Splinting/pushing on or around the vagina/perineum, to start of complete defecation
- Sexual:
- Dyspareunia (pain with sex)
- Decreased sexual desire due to body image issues associated with prolapse
- Routine pap smear
- Pelvic ultrasound
- Intravenous Pyelogram (IVP): Urinary tract x-ray
- CT/MRI scan: Of the pelvis
- Pelvic Physiotherapy: To strengthen the pelvic floor muscles
- Pessary: Device is inserted into the vagina to provide support to related pelvic structures and to relieve pressure on the bladder and bowel
- A wide variety of pessaries (made of silicone/plastic) are available for those who are not candidates for surgery or have temporary issues post-pregnancy
- Fitted based on the nature and extent of the prolapse and the patient’s cognitive status, manual dexterity and level of sexual activity
- Size of the vagina is estimated and the appropriate size and shape of pessary is inserted to effectively reduce the prolapse
- Reconstructive Surgery: Aims to correct the prolapsed vagina while maintaining/improving vaginal sexual function and relieving any associated pelvic symptoms
- Can be done through an abdominal incision/laparoscopically/vaginally
- Sacrocolpopexy Surgery: Suspends the upper vagina with synthetic mesh
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- Can be done through an abdominal incision/laparoscopically
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- Vaginal Surgery: Either the upper vagina/cervix is attached to the ligament between the ischial spine and the sacrum (sacrospinous ligament) or to the ligaments between the sacrum and uterus (uterosacral ligaments)
- Obliterative Surgery: Closes off the vaginal canal either partially/completely
- Typically reserved for women who are no longer sexually active
