Pelvic Floor Prolapse
Pelvic foot prolapse is the medical term for the collapse of the bladder,
rectum, small intestine, or uterus into the vagina- it occurs in women
who have had either vaginal deliveries or a hysterectomy, although it
does not occur in ALL women who have had either. The causes of the problem
are not clearly understood, although it appears that both mechanical injuries
to the muscles of the pelvic floor during vaginal delivery, as well as
hormonal depletion during menopause, play a role.
The degree of prolapse is graded, with grade I being the mildest, and
grade 4 being the most severe. In grade 4 prolapse, the bladder, rectum,
small intestine, or uterus is lilting up the vagina. Prolapse is dangerous
only if it causes inability to urinate or defecate, recurrent urinary
tract infections, or breakdown and ulceration of the vaginal wall. Nearly
all grade 4 de1ec~s must be repaired; grade I to 3 defects are repaired
based on their degree of discomfort.
Cystocele: The bladder falls into the vaginal canal. BLADDER
Enterocele: The small intestines fall into the vaginal canal. The patient
must have had a hysterectomy for this to occur.
Uterine prolapse: The uterus falls into the vaginal canal.
The most common symptoms include:
1. Pressure in the vaginal area.
2. Incontinence: leakage of urine to any degree.
3. Sense of incomplete emptying upon urination.
4. Urgency: cannot get to the toilet in time when the urge hits.
5. Recurrent urinary tract infections.
Pelvic exam: Will reveal the presence of the prolapse and the grade.
Urine culture: Evaluate for a urinary tract infection.
Bladder ultrasound: Cheek for incomplete emptying!
Cystoscopy: A procedure during which a scope is inserted into the urethra
in order to inspect the bladder and the ureteral orifices.
Kidney ultrasound: Looks at the kidneys and ureters for dilatation that
may be caused by the prolapse.
MRI: Sometimes can help determine which organs have prolapsed.
Pelvic floor prolapse is an anatomic defect in the muscles of the pelvic
floor. The two options for treatment include insertion of a pessary and
Pessary: A pessary is a rubber device that is inserted into the vagina,
similar to a diaphragm that is used in birth control. Many different types
of pessaries are available, depending on the problem that needs~ to be
corrected. Generally, pessaries are used in less active patients! They
need to be removed, cleaned, and reinserted on a regular basis.
Surgery: Definitive treatment involves surgery to replace the prolapsed
organs into their original position. Different surgeons perform the surgery
indifferent ways. I correct all of the defects through the vagina, with
only a small puncture site in the pubic bone; I use prolene mesh to support
the muscles, similar to the material used for inguinal hernia repairs.
Exercises and biofeedback will not correct the problem.