Pelvic Floor Prolapse

GENERAL INFORMATION

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.

DEFINITIONS

Cystocele: The bladder falls into the vaginal canal. BLADDER RECTUM VAGINA

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.

SYMPTOMS

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.

EVALUATION

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.

TREATMENT

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 surgery.
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.