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Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the female pelvic floor muscles and ligaments become weak and can no longer support the pelvic organs. The uterus drops down into the vaginal canal, eventually protruding outside of the vagina.

Pelvic organ prolapse causes several conditions:

  • Cystocele: A cystocele occurs when the wall between the bladder and vagina weakens and lets the bladder drop into the vagina. This condition may cause discomfort and problems with emptying the bladder (urination).
  • Enterocele: An enterocele occurs when the upper rear vaginal wall weakens and lets the small bowel drop into the vagina. This condition may cause a pulling sensation and backache that is reduced when you lie down.
  • Rectocele: A rectocele occurs when the lower rear vaginal wall weakens and lets the rectum into the vagina. This condition may cause difficulty with bowel movements.

There are 4 stages of uterine prolapse

  • First: The cervix droops into the vagina
  • Second: The cervix drops to the level just inside the opening of the vagina
  • Third: The cervix is just outside of the vagina
  • Fourth: The uterus is outside of the vagina
Causes and Risk Factors

Pelvic organ prolapse has several factors that can weaken the pelvic muscles:

  • Damage to the supportive tissue during childbirth
  • Loss of estrogen after menopause
  • Advanced aging
  • Obesity
  • Pregnancy
  • Chronic coughing
  • Constipation
Symptoms

The symptoms are usually less bothersome in the morning and worsen as the day continues. Symptoms may include:

  • Feeling of heaviness, pressure, or pulling in the pelvis
  • Feeling like you are sitting on a ball
  • Feeling as if something is falling out of the vagina
  • Tissue protruding from the vagina
  • Urinary problems, such as urine leakage, urine retention, the sudden urge to empty the bladder or repeated bladder infections
  • Difficulties having a bowel movement
  • Lower back pain
  • Feeling of looseness in the vagina during sex
  • Vaginal bleeding
  • Constipation
Treatment

There are several treatments for pelvic organ prolapse.

Non-Surgical

  • Weight loss
  • Kegel exercises to help strengthen the vaginal muscles
  • Estrogen replacement therapy
  • Pessary device, which is inserted into the vagina to help keep the uterus and cervix in place

Surgical, including Laparoscopic, abdominal, or vaginal

  • Hysterectomy
  • Uterine suspension, which places the uterus back into its original position through reattaching the ligaments or using synthetic materials
  • Robotic

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