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Uterine Prolapse

Pelvic Organ Prolapse

What is pelvic organ prolapse?

Pelvic organ prolapse occurs when a pelvic organ-such as your bladder-drops (prolapses) from its normal spot in your lower belly and pushes against the walls of your vagina. This can happen when the muscles that hold your pelvic organs in place get weak or stretched from childbirth or surgery. Many women will have some kind of pelvic organ prolapse. It can be uncomfortable or painful. But it isn't usually a big health problem. It doesn't always get worse. And in some women, it can get better with time. More than one pelvic organ can prolapse at the same time. Organs that can be involved when you have pelvic prolapse include the: Bladder. This is the most common kind of pelvic organ prolapse. Urethra . Uterus . Vagina . Small bowel . Rectum

The diagnosis and management can require a team approach with your gynecologist, perhaps pelvic physical therapy and a gyn-urologist. Our office will help you coordinate these modalities based on your symptoms and needs.

What causes pelvic organ prolapse?

Pelvic organ prolapse is most often linked to strain during childbirth. Normally your pelvic organs are kept in place by the muscles and tissues in your lower belly. During childbirth these muscles can get weak or stretched. If they don't recover, they can't support your pelvic organs.Pelvic organ prolapse can be made worse by anything that puts pressure on your belly, such as:Being very overweight (obesity). A long-lasting cough. Frequent constipation.Pelvic organ tumors. Older women are more likely to have pelvic organ prolapse. It also tends to run in families.

What are the symptoms?

  • Feeling pressure from pelvic organs pressing against the vaginal wall/Feeling very full in your lower belly.
  • Feeling as if something is falling out of your vagina /Feeling a pull or stretch in your groin area or pain in your lower back.
  • Releasing urine without meaning to (incontinence), or needing to urinate a lot.

How is it treated?

Decisions about your treatment will be based on which pelvic organs have prolapsed and how bad your symptoms are. If your symptoms are mild, you may be able to do things at home to help yourself feel better. You can relieve many of your symptoms by adopting new, healthy habits. Try special exercises (called Kegels) that make your pelvic muscles stronger. Reach and stay at a healthy weight. Cut back on caffeine, which acts as a diuretic and can cause you to urinate more often. Avoid lifting heavy things that put stress on your pelvic muscles.

If you still have symptoms, your doctor may have you fitted with a device called a pessary to help with the pain and pressure of pelvic organ prolapse. It is a removable device that you put in your vagina. It helps hold the pelvic organs in place. But if you have a severe prolapse, you may have trouble keeping a pessary in place.

Placement of a Pessary

Placement of a Pessary-graph1

Placement of a Pessary-graph2.jpg

The picture above shows how a pessary should fit. The most common types of pessaries are the shown. A pessary is used to support areas of pelvic organ prolapse.Your doctor will try to find a pessary that fits you. It should not cause any pain. You may need to try different shapes and sizes of pessaries to find one that fits you just right.Your doctor will show you how to take out and clean the pessary and how to put it back into place. This should be done on a regular schedule. If it is hard for you to take out your pessary or to put it back into place, you can have it done at your doctor's office.

Pelvic Organ Prolapse – Surgery

  • Surgery is another treatment option for serious symptoms of pelvic organ prolapse. But you may want to delay having surgery if you plan to have children. Pelvic organ prolapse can come back after surgery. Doing Kegel exercises to make your pelvic muscles stronger will help you recover faster from surgery. The two together can help you more than surgery alone.
     
  • If you have pain and discomfort from pelvic organ prolapse that does not respond to nonsurgical treatment and lifestyle changes, you may want to consider surgery. The choice of surgery depends upon which organs are involved, how bad your symptoms are, and what other medical conditions are present. Also, your surgeon may have experience with and preference for a certain procedure. The goals of surgery are to relieve your symptoms and restore the normal functioning of your pelvic organs.

 

© Copyright 2012, Mary J. Kotob, MD, FACOG. All rights reserved.
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