Introduction to Pelvic Floor Reconstruction
If you have been diagnosed with pelvic organ prolapse, the muscles of the pelvic floor might have been damaged or become weak. The pelvic floor consists of the muscles, ligaments, connective tissue and nerves that support and control the rectum, uterus, vagina, and bladder. These weakened or damaged muscles are often the result of childbirth, repeated heavy lifting, chronic disease, or surgery and result in the inability to support the weight of some or all of the pelvic and abdominal organs. Due to the lack of support, the organs may drop (prolapse) below their normal positions and cause symptoms such as discomfort, pain, pressure and urinary incontinence.
About 35% of women will develop some form of pelvic organ prolapse in their lives. Physicians will often time try to treat pelvic floor prolapse by a variety of nonsurgical therapies first, but many females have found successful treatment with pelvic floor reconstruction surgery. This surgery, performed by Plano, Frisco and Dallas, Texas area urologist Dr. Mark Allen, consists of several procedures for correcting pelvic organ prolapse, and the overall goal is to restore the normal structure and function of the female pelvic organs.
Pelvic Organ Prolapse Symptoms
Symptoms of pelvic organ prolapse include:
- Feeling pressure from pelvic organs pressing against the vaginal wall. This is the most common symptom.
- 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.
- Having pain in your vagina during sex.
- Having problems with your bowels, such as constipation.
- Bladder problems
- Incontinence- Loss of bladder or bowel control and leakage or urine or feces.
- Emptying disorders- Difficulty urinating or moving bowels
- Pain- discomfort, burning or other uncomfortable pelvic symptoms, including bladder or urethral pain
- Overactive bladder- Frequent need to urinate, uncomfortable bladder pressure, urge incontinence and difficulty holding a full bladder
These symptoms are often made worse with physical activities such as prolonged standing, jogging or bicycling.
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.
You may also get pelvic organ prolapse if you have surgery to remove your uterus (hysterectomy). Removing the uterus can sometimes leave other organs in the pelvis with less support.
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 cancers.
Older women are more likely to have pelvic organ prolapse. It also tends to run in families.
Types of Pelvic Organ Prolapse
Cystocele, the bulging bladder– A cystocele occurs when the wall between a woman’s bladder and her vagina weakens and allows the bladder to droop into the vagina. A cystocele forms when the normally flat upper vaginal wall loses its support and sinks downward. This condition may cause discomfort and problems with emptying the bladder. When a cystocele becomes advanced, the bulge may become visible outside the vaginal opening. A bladder that has dropped from its normal position may cause two kinds of problems—unwanted urine leakage and incomplete emptying of the bladder. In some women, a fallen bladder stretches the opening into the urethra, causing urine leakage when the woman coughs, sneezes, laughs, or moves in any way that puts pressure on the bladder.
Enterocele, the female hernia– An enterocele occurs when your small intestine (small bowel) drops into the lower pelvic cavity and protrudes into your vagina, creating a bulge. An enterocele is a vaginal hernia. To repair the enterocele, the supportive structure must be reconstructed. Among all types of female prolapse, enteroceles share the most similarities with hernias that can develop in the abdominal and groin areas of both women and men: both involve bulging of the intestines into weakened supports nearby. In a man, hernias bulge through the abdominal wall; in a woman, enteroceles bulge into the top of the vagina. The symptoms are often vague, including a bearing down pressure in the pelvis and vagina, and perhaps a lower backache. They often exist alongside vaginal vault prolapse in women who have had a hysterectomy.
Rectocele, the bulging rectum– A rectocele occurs when the tissues and muscles that hold the end of the large intestine (rectum) in place are stretched or weakened. This can allow the rectum to move from its natural position and press against the back wall of the vagina. Sometimes the tissues separating the two are so weak that the rectum bulges into the back wall of the vagina.
This creates an extra pouch in the normally straight rectal tube. Rectoceles often cause symptoms in their early stages and the symptoms are related to incomplete emptying of the rectum. Even a rectocele bulge that cannot be visualized at the vaginal opening may cause difficulty with bowel movements – including the need to strain more forcefully, a feeling of rectal fullness even after a bowel movement, increased fecal soiling, and in some cases incontinence of stool or gas. Those symptoms result from stool and air remaining within the rectocele pouch even after defecation, in contrast to the normal rectum, which fully empties.
Vaginal vault prolapse– Vaginal vault prolapse occurs when the upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal or outside of the vagina. It may occur alone or along with prolapse of the bladder (cystocele), urethra (urethrocele), rectum (rectocele), or small bowel (enterocele). Vaginal vault prolapse is usually caused by weakness of the pelvic and vaginal tissues and muscles. It happens most in women who have had their uterus removed (hysterectomy). During surgery, the top of the vagina is attached to the lower abdominal wall, the lower back (lumbar) spine, or the ligaments of the pelvis. Surgical repair is common and be performed by a number of vaginal, abdominal, and even laparoscopic incisions and may involve use of either your tissue or artificial material.
Pelvic Floor Reconstruction and Other Treatment Options
Depending on the exact nature of your prolapse and its severity, you and your physician may discuss:
1. Changes to your diet and fitness routine
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.
2. Considering a pessary- a rubber or plastic device, inserted vaginally and designed to relieve symptoms when in place
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 holds the pelvic organs in place. But if you have a severe prolapse, you may have trouble keeping a pessary in place.
3. Surgical procedures to improve the prolapse.
Pelvic floor reconstruction 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. The strain of childbirth could cause your prolapse to come back. In recent years, dramatic advances have been made in the surgical treatment of this common gynecological condition.
You may want to consider surgery if:
- You have a lot of pain because of the prolapsed organ.
- You have a problem with your bladder and bowels.
- The prolapse makes it hard for you to enjoy sex.
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 pelvic floor reconstruction surgery. The choice of surgery depends upon which organs are involved, how bad your symptoms are, and what other medical conditions are present. In addition, 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.
For additional resources on pelvic organ prolapse, or to discuss pelvic floor reconstruction with a board certified urologist, please contact the Plano, Frisco and Dallas, Texas office of Dr. Mark Allen.