Pelvic organ prolapse occurs in women when pelvic floor muscles don't support the uterus, bladder, ureter, vagina, cervix, small intestines and/or the rectum. When these organs drop out of position, it's called a prolapse.
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Symptoms of pelvic organ prolapse may include:
These pelvic floor muscles get stretched or torn during delivery. Women who have had lots of children are the most likely to experience prolapse. These muscles may also weaken as a woman gets older. Other causes or predispositions include:
A physical exam is required for diagnosis. You might be asked to bear down to see the extent of prolapse. Other tests help your doctor evaluate your individual prolapse situation. These tests include:
Other advanced tests may be ordered to determine how severe the prolapse is so that your medical team can plan the best treatment to prevent recurrence.
Non-surgical treatments include pelvic floor exercises, called Kegels. The patient contracts and relaxes the pelvic floor muscles to strengthen them. Bio-feedback allows patients to learn to exercise the exact areas which need strengthening. Other potential non-surgical treatment options may be recommended:
Hormone therapy may be used before surgery to help strengthen weak muscles and help with vaginal dryness. Estrogen therapy is not appropriate for every woman.
Surgery is recommended when the prolapse is severe or causes major pain. Patients and their physicians consider multiple factors before deciding on surgery, including sexual activity and if the patient wants more children.
Depending on the type of repair, surgery may be through the vagina or abdomen. It may be done laparoscopically or robotically-assisted. An open incision allows a surgeon to tack the vagina to the tailbone. Mesh is sometimes used. It's important to realize that surgery only corrects the bulge, but does not address the underlying cause which is weak pelvic floor muscles. Prolapses may recur.
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