Pelvic prolapse or vaginal vault prolapse is a very common condition characterized by the herniation of pelvic organs, bladder (cystocele), rectum, (rectocele), small intestine (enterocele), uterus, or vagina. These organs herniated due to weakness of support structures in the pelvis. The supporting muscles can become torn or stretched due to a number of things, including childbirth or age. Other risk factors for pelvic prolapse include: genetics, connective tissue disorder, obesity, and frequent constipation.
Patients may notice a bulge in the vagina, and may even have to reduce this bulge manually in order to urinate or defecate. Patients may also have urinary incontinence accompanying the prolapse. This surprisingly may improve as the prolapse worsens. Furthermore, patients can also complain of constipation, and dyspareunia (painful intercourse), back pain and can have recurrent urinary infections.
Diagnosis begins with a thorough history and physical exam. A urinalysis is useful to evaluate blood in the urine or infection. A post void residual is obtained to ensure the patient is emptying. Other important tests that may be done include a cystoscopy and urodynamics which provide comprehensive evaluation of the bladder function and pelvic floor.
Nonsurgical Treatment Options
Treatment options may include conservative options such as pelvic floor retraining, biofeedback, and a placement of a pessary. A vaginal pessary is a removable device that is designed to support the areas that may cause pelvic organ prolapse. Our staff is trained to place the pessaries in the office.
Surgical Treatment Options
Surgical treatment options include various procedures that address the pelvic floor defect. The da Vinci robot is used to repair pelvic floor defects. This procedure is called a da Vinci Sacrocolpopexy.
The robotic procedure allows the surgeon to work deep in the pelvis to recreate the suspension. Often, a small piece of mesh is used to help with this.
Several advantages are noted utilizing this technique. These include shorter hospitalization stay, less blood loss, and return to normal function sooner. Our physicians are trained to deal with all types of pelvic floor prolapse.