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Feeling like there is a bulge in the vaginal area? Notice it more at the end of the day? Or with heavy lifting? You are not alone. Many women experience the same symptoms. Prolapse is a term used to describe when the anterior, posterior or apical aspects of the vagina have fallen. Risk factors for vaginal prolapse include vaginal deliveries, chronic straining with heavy lifting, chronic constipation, changes in the tissues with aging, and genetics/family history. Prolapse of the vaginal tissues is especially important to evaluate if you have difficulty emptying your bladder or bowel. Some women may experience recurrent urinary tract infections.

Diagnosis

Prolapse can be diagnosed with a simple pelvic exam. The physician will determine if there is an anterior vaginal wall, posterior vaginal wall and/or apical prolapse. Some patient may require evaluation of bladder emptying.

Treatment of Vaginal Prolapse

Kegel Exercises

Exercises of the vaginal muscles that strengthen the pelvic floor. These exercises have been shown to improve urinary incontinence, urinary frequency/urgency as well as fecal incontinence. Kegel exercises can be used to address mild prolapse.

Pelvic floor physical therapy

Meeting with a specialist in pelvic floor physical therapy to learn exercises and techniques that are known to improve the pelvic floor muscles. Pelvic floor physical therapy can be used to improve mild prolapse, stress urinary incontinence, urge urinary incontinence, urinary frequency, urinary urgency and fecal incontinence.

Pessary

A ring of plastic or silicone that can be placed in the vagina such that it supports the urethra and a prolapsing vagina. There are various shapes and sizes of pessaries. Some pessaries may work better than others. Not everyone will have success in finding a pessary that works for them, but most patients will. The pessary requires cleaning periodically. If you are unable to clean your own pessary, we can schedule you to come in periodically for a cleaning.

Surgery

There are various options for surgical management. There are vaginal and laparoscopic or robot-assisted laparoscopic approaches to surgery. All surgeries are designed to resuspend a prolapsing vagina. The surgery option for you may vary depending on your age, type of prolapse, medical issues and sexual health.

Vaginal Traditional Repair Surgery

Surgery using your own tissue via a vaginal approach. The prolapsing vagina is often resuspended using ligaments in the pelvic area by doing an anterior colporrhpaphy, vaginal vault resuspension and/or posterior colporraphy. An alternative vaginal surgery, colpectomy, involves closing the vaginal opening so that the organs are supported. These surgeries may involve a hysterectomy.

  • Anterior Colporrhpahy: Using suture to repair the anterior vaginal wall thereby supporting the bladder. This surgery can be performed alone or in conjunction with other prolapse repair surgeries. Patients are usually on postoperative restrictions for six weeks.
  • Vaginal Vault Prolapse: A vaginal surgery consisting of sewing the top of the vaginal to the nearby ligaments such as the uterosacral ligaments or sacrospinous ligaments.
  • Posterior Colporrhaphy: Using suture to repair the posterior vaginal wall thereby supporting the rectum. At times, this surgery may be performed with a perineorrhaphy if the muscles supporting the perineum between the vagina and anus are weak.
  • Perineorrhaphy: Some women may find they must press with their fingers on the perineum to assist with bowel movements if the perineal muscles are separated. This procedure involves reapproximating the muscles of the perineum using suture.

Laparoscopic Surgery

This type of surgery, performed through multiple small incisions, resuspends the vagina either using your own tissue or using a graft. You may have heard of a “robotic surgery”, or robot-assisted laparoscopic surgery, in which a robot is used to hold the instruments during surgery. Laparoscopic/Robot-assisted laparoscopic surgeries are usually performed to correct apical prolapse, or when the top of the vagina is falling. The current gold standard surgery for apical prolapse repair is called a sacrocolpopexy. This surgery involves sewing a graft to the vagina and connecting the other end of the graft to the ligament in front of the spine. This surgery has been used for decades and has many studies demonstrating good outcomes.

Robotic Surgery

Also known as robotic-assisted laparoscopic surgery, robotic surgery is the use of a robot to hold and manipulate the surgical instruments under the command of the surgeon. While you may imagine R2-D2 or C3PO with you in the OR, the reality is that the robot is just a tool that allows the surgeon not to fatigue during surgery and move the surgical instruments in a way to cause less trauma to the tissues. Robotic surgery has been found to reduce pain and blood loss in some studies. Dr. Canter performed the first robotic hysterectomy in the DC Metropolitan area in 2006.

The information about prolapse was reviewed by Dr. Maria Canter. If you have any questions, please don’t hesitate to contact us using our contact form below.

Call Urogynecology Center NoVa today to schedule a consultation.703-293-5239