Vaginal prolapse is a lack of support for the pelvic structures (Uterus, intestines, bladder and/or rectum) that results in a hernia or bulging of these organs into the vagina. Women with this problem often have the sensation of pressure in the pelvis or “something falling out of me.” In more extreme cases the prolapse is outside the vagina and will block the flow of urine and or bowel movements. The condition is usually painless but can cause “discomfort”. The symptoms tend to worsen as the day progresses and you are up on your feet.
This condition has various degrees of progression. It is a quality of life condition. No one knows exactly why it occurs. It is associated with childbirth, obesity, chronic straining (constipation, heavy lifting), and smoking. It can also occur for no reason at all.
There are both surgical and non-surgical ways to treat prolapse. Traditionally, surgery has had a high failure rate with prolapse coming back almost 50% of the time. The key to proper management of your prolapse is a detailed evaluation.
Evaluation of prolapse:
There are multiple portions of the vagina that can be involved in prolapse. It is important to determine which portion(s) of the vagina and what underlying organs (bladder, rectum, uterus, intestines and to what degree) are involved in your prolapse. In some cases prolapse does not cause any symptoms. When prolapse is bothersome it is very important to determine what portion(s) of your prolapse is causing your particular symptoms and most importantly that you see a Board Certified Urogynecologist who has expertise in both urological and gynecological procedures.
Traditionally surgery is performed either through the abdomen or the vagina and may involve a hysterectomy. Vaginal procedures are most commonly performed. Vaginal repairs traditionally incorporated various plication procedures using the patient’s native tissues. These techniques relied upon the hope that the scarring from the surgical repair would be adequate to hold the prolapsed segment(s) of the vagina in place. Unfortunately the failure rate was high. Advances in the surgical management of prolapse have incorporated the use of biological and or synthetic grafts to augment the patient’s deficient tissues. Many new surgical devices have facilitated the use of graft augmentation. Your Dr. will determine which procedure is appropriate for you.
The pessary is the mainstay of non- surgical management of prolapse. A Pessary is a silicone vaginal insert that holds prolapse in place. Pessaries are available in many sizes and shapes. It is typically inserted and removed by the patient. With a properly fit pessary you won’t even know it’s there.
Pelvic floor exercises (KEGEL EXERCISES) / Pelvic Floor Rehab
These exercises help to strengthen the pelvic floor musculature. These exercises will not reverse prolapse but may prevent or at least slow down the progression of prolapse.
Female problems of the urinary and gynecological systems are often times very complex and intimately related. Therefore, these problems are not adequately addressed independently by a urologist or a gynecologist so patients are “bounced” between two specialists. Florida Urogynecology offers expertise in both female urology and gynecology to address all aspects of your problem.
There are many ways to address urogynecological problems – both surgical and non- surgical. These issues, such as urinary incontinence, have a tremendous impact on your quality of life and are commonly accepted as a “natural part of growing older”. That is simply not true. Our goal is to do a thorough evaluation of your problem and provide the information for you to have a better understanding of your problem. By working together we will tailor a plan specific to your needs. Your insight allows you to take control of the situation and make informed decisions.
NON SURGICAL OPTIONS
– Pelvic Floor Rehabilitation
– Medical Management
– Incontinence Sling
– Urethral Bulking
– Vaginal Prolapse Repair (abdominal / vaginal /robotic approaches)
– Cystocele Repair (Bladder Repair)
– Rectocele Repair (Rectal Repair)
– Enterocele Repair (Bowel hernia at the top of the vagina)
– Vaginal Vault Suspension
– Uterine Suspension
– Endometrial Ablation
– Nerve blocks for pain
– BOTOX injections
– Neuromodulation for overactive bladder, significant urgency, frequency, nonobstructive
urinary retention and fecal incontinence.
– Fistula Repair
Not all doctors have the same training and experience to address urogynecological problems. When surgery is an option, your best chance for long-term success is with your initial procedure. It is important to seek expert evaluation from the start.