Treating ‘Pelvic Organ Prolapse’

Once rarely discussed, pelvic organ prolapse is now more widely recognized as a women’s health condition with several treatment options.

Pelvic organ prolapse occurs when the supporting structures of the pelvic region become weakened and relaxed, allowing one or more of the pelvic organs – the bladder, uterus, vagina, small bowel and rectum – to drop and press into the vaginal wall.

“Although pelvic organ prolapse is not a lethal condition – in other words, you will not die sooner if you have the condition – it does affect quality of life for many women. It can be pervasive and distressing,” explained gynecologic surgeon Rafael Perez, M.D., medical director of the Fibroid Center at South Miami Hospital’s Center for Women & Infants.

Women with mild prolapse discovered during a routine pelvic exam may have no symptoms. But others can experience a range of symptoms depending on which organ is drooping.

Pelvic Organ Prolapse Symptoms:

• Pelvic pressure and pain, leg fatigue and lower back pain
• Urinary problems, such as urinary incontinence or difficulty in starting to urinate
• Bowel problems, such as fecal incontinence or trapped stool, which can cause pain and constipation
• Painful intercourse

As women age, pelvic organ prolapse becomes more common. More than 30 percent of postmenopausal women will experience some form of pelvic organ prolapse, Dr. Perez says.

“Its cause is multifactorial,” he explained. “Genetics may play a role. Connective tissues may be weaker in some women, placing them more at risk.”

Other Common Causes Include:

• Pregnancy, labor, and childbirth
• Obesity
• Respiratory problems with a chronic, long-term cough
• Constipation
• Pelvic organ cancers and damage caused by treatments
• Surgical removal of the uterus (hysterectomy)

Treatment for Pelvic Organ Prolapse

The severity of a woman’s symptoms helps doctors determine treatment. Pelvic floor therapy is a specialized physical therapy that strengthens muscles in the lower pelvis. “Behavioral treatments are good options for patients with mild pelvic organ prolapse,” Dr. Perez said. “Patients may attend several therapy sessions and then continue the exercises at home.”

Vaginal pessary – a small device similar to a diaphragm or cervical cap – can be inserted in the vagina to help support the pelvic area. “This is an alternative for women who will not benefit from pelvic floor therapy but may not be good surgical candidates or want to delay surgery,” Dr. Perez explained.

Surgical treatment, tailored to meet the specific needs of each patient, is the only definitive way to relieve symptoms and improve quality of life for some women. “The good news is that there are many minimally invasive ways to perform this surgery, which results in a shorter recovery time for the patient,” Dr. Perez said.

Using laparoscopic or robotic surgery, the prolapsed organ or organs can be repositioned and secured with stitches to the surrounding tissues and ligaments. Ricardo Estape, M.D., of the Center for Robotic Surgery at Baptist Health South Florida, employs robot-assisted techniques to overcome the limitations traditional surgery can impose when operating within the confined pelvic space.

“The increased precision and magnified view into the body that the robot-assisted surgical system provides allows us to work around the delicate pelvic organs with accuracy, reducing blood loss and trauma to the body, and helping to avoid complications sometimes associated with these advanced procedures,” Dr. Estape said.

To reduce the likelihood of having pelvic organ prolapse, women can try these steps:

• Do Kegel exercises daily to maintain good muscle strength in the pelvic area
• Maintain a healthy weight
• Avoid constipation
• Do not smoke, as smoking can affect tissues and a chronic cough often seen in smokers increases the risk of problems

Patients with pelvic pain can attend an Interstitial Cystitis and Pelvic Pain Support Group meeting at South Miami Hospital, 2-4 p.m., August 30 and November 1, in the Victor E. Clarke Education Center, Classroom E. For more information or to register, call 786-596-3812.

Tags: Fibroid Center, pelvic floor disorders, South Miami Hospital Center for Women & Infants