SUMMA HEALTH SYSTEM A Woman’s Guide to Pelvic Health Pelvic Organ Prolapse (POP) The pelvic floor is a group of muscles Pelvic organ prolapse (POP) Pelvic organ prolapse is a common, that form a sling or hammock occurs when pelvic muscles and treatable medical condition which across the opening of a woman’s tissues become weakened, stretched affects an estimated one- pelvis. These muscles, along with or are injured as a result of childbirth, third of all women – and half connective tissues, ligaments and repeated heavy lifting, chronic of all women ages 55 and nerves keep all of the pelvic organs in disease, obesity or surgery. When the older. While pelvic organ prolapse place and control the rectum, uterus, pelvic floor tissues which hold pelvic can affect women of all ages, the risk vagina and bladder. organs in place become weakened of developing POP increases with age. or stretched, it can cause the pelvic Post-menopausal women are at the Pelvic organ prolapse may include one • Uterus or womb • Stage 4: The uterus is completely organs to bulge (or prolapse) into highest risk for developing POP. (or more) of the following conditions, (procidentia): Where a group of out of the body. This condition also the vagina. The pelvic organs may including prolapse of the: ligaments (uterosacral and cardinal is called complete prolapse ligaments) at the top of the vagina (procidentia). prolapse past the vaginal opening, • Bladder (cystocele): Where weaken, causing the uterus to fall, and more than one pelvic organ can the front wall of the vagina • : Vaginal vault which weakens both the front and Vaginal vault prolapse at the same time. (pubocervical fascia) weakens prolapse may occur following a back walls of the vagina as well. and the bladder pushes against hysterectomy surgery (removal of the vagina, producing a bulge. There are several stages of uterine the uterus). The uterus provides Spine Ovary Pelvic pressure or protrusion are prolapse, including: support for the top of the vagina common symptoms. Urinary stress and about 10 percent of women • Stage 1: The uterus descends Rectum incontinence (urine leakage during who undergo a hysterectomy Uterus into the upper portion of the coughing, sneezing, laughing or develop some degree of vaginal Cervix vagina. exercise) related to weakness of the vault prolapse, where the top of Bladder urethra also may be a symptom. • Stage 2: The uterus descends the vagina falls toward the vaginal Pubic Bone to the opening of the vagina. opening. This can cause the walls of • Rectum (rectocele): Where Vagina the vagina to weaken. The condition Urethra the back way of the vagina • Stage 3: The cervix, located at can progress to where the top of the (rectovaginal fascia) weakens and the opening of the uterus, sags vagina may protrude outside of the the rectum pushes against the past the vaginal opening and body through the vaginal opening, vagina, producing a bulge. Pelvic may protrude outside the body. turning the vagina “inside out.” pressure, protrusion and difficulty Leg with bowel movements may result. 2 3 Treatment A urogynecologist can recommend a variety of therapies to relieve symptoms of prolapse, urinary or fecal incontinence or other pelvic floor symptoms. He/she may advise conservative (nonsurgical) or surgical treatment, depending on the severity of your condition and your overall health. Symptoms What’s A Women with pelvic organ prolapse uterus, bladder, vagina or rectum. Urogynecologist? may experience the following: Some patients report feeling like A urogynecologist is an they are sitting on a ball or other • Incontinence – A loss of bladder obstetrician/gynecologist who object. or bowel control resulting in the specializes in the care of women leakage of urine or feces from • Emptying disorders – Difficulty in with pelvic floor disorders. the body. This also includes what urinating or moving the bowels. Urogynecologists have completed your doctor may call stress medical school and a four-year • Pelvic or bladder pain – incontinence, which is an inability residency in obstetrics and Discomfort, burning or other pelvic to “hold it” (leaking urine) while gynecology. They also complete symptoms, including bladder or laughing, sneezing, coughing or additional fellowship training in urethral pain. Pain or pressure in running. the evaluation and treatment of the vagina. conditions that affect the female • Prolapse – The descent of pelvic • Overactive bladder – Frequent pelvic organs and the muscles and organs in the lower abdomen, need to urinate, bladder pressure, connective tissue that support the resulting in a bulge and/or a feeling urgency, urge incontinence or pelvic organs and the surgical and of pressure in the vagina or rectum. difficulty holding back a full nonsurgical treatment of non- May be referred to as a “dropped” bladder. cancerous gynecologic conditions. 4 5 Conservative, nonsurgical Surgical Prolapse treatment options include: Options Colpopexy Colpopexy is a surgical procedure • Medications which can improve • Vaginal devices (also called Surgical procedures used to used to reposition a woman’s vagina bladder or bowel control by pessaries) which are inserted into treat pelvic organ prolapse and which has moved from its correct blocking the signals from the the vagina and provide additional incontinence may be performed position within the pelvic cavity. nervous system which cause support for the pelvic organs using minimally invasive surgical During this procedure, also called urgency techniques. These procedures • Biofeedback and electric vaginopexy or vaginofixation, can often be performed on an • Pelvic exercises (Kegels) or physical stimulation therapies to improve a surgeon attaches the vagina to outpatient or overnight basis. therapy which strengthen the pelvic bladder and bowel control surrounding tissue in the abdomen to These procedures are designed muscles hold it in place. There are two major • Vaginal estrogen hormone to provide permanent support for types of colpopexy: • Behavioral and/or dietary replacement therapy may reduce the pelvic organs. • Vaginal sacrospinous or in place to support it. The mesh surgeon will make small incisions modifications weakness in the pelvic floor uterosacral colpopexy: Surgery may be made of either synthetic in the vagina and attach mesh to is performed through the vagina, material or the patient’s own provide support to the bladder or which allows repairs to be made tissue (fascia), depending on the rectum. This is reserved for older in a minimally invasive fashion. surgeon’s preference. women who are not sexually active. The vagina is sutured (sewn) to Urethral sling procedure Laparoscopic uterine the sacrospinous ligament to Urethral sling procedure is a surgical suspension hold it in the correct position or procedure where a tape made of Laparoscopic uterine suspension the uterosacral ligaments are either synthetic or biologic material is is the treatment of choice where reattached to the top of the vagina. used to support the urethra (the tube preservation of the uterus is desired. • Sacrocolpopexy: This is an which allows urine to exit the body Laparoscopic uterine suspension is approach where the surgeon from the bladder) in the treatment of usually done in conjunction with a makes a small incision in stress incontinence. vaginal vault suspension, a procedure the abdominal wall or uses a which attaches the vagina to Vaginal mesh procedures laparoscope/robot and performs ligaments located in the back of the Vaginal mesh procedures are the surgery through tiny incisions. pelvis. minimally invasive procedures used The vagina is repositioned to the to treat bladder or rectal bulges into correct location within the pelvic the vagina. During the procedure, the cavity and then mesh is sutured 6 7 What’s the Right Surgical Stress Incontinence Technique for You? Coaptite® injections: A procedure Mid-urethral sling procedure: Pubovaginal slings: Similar to a Talk to your doctor about your The decision about which surgical where a water-based gel containing A procedure in which a surgeon mid-urethral sling procedure, but in options. Minimally invasive surgical technique is right for you is an particles made of calcium makes a small incision in the this procedure, a biological tissue techniques give surgeons the important one. Your surgeon will hydroxylapatite is injected around vagina and places a sling under instead of a synthetic material is ability to operate through very take into account many factors the urethra to build up the area and the urethra and attaches it to the used to create a sling under the small incisions without cutting before choosing which technique tighten the sphincter muscles near connective tissue in the pelvis. urethra. through large area of skin and to use, including: your past medical the opening of the bladder. Different types of slings are muscle. Specialized instruments history, previous surgeries, overall available – the correct type may and a laparoscope (a thin, lighted health status and anatomy. be selected through preoperative tube with a tiny camera) or robot No matter which surgical technique bladder testing (urodynamics). enable surgeons to perform your doctor chooses, it is important procedures with an enhanced view to remember that all surgical of the surgical field, while allowing procedures involve some risk them to perform precise, delicate of complications. Before having movements with specially-designed any type of surgery, discuss all instruments. treatment options carefully