Prolapse of the Pelvic Organs
Pelvic organ prolapse is the bulging of one or more pelvic structures into the vagina and, at times, out of the vaginal opening. The vagina is surrounded by a variety of pelvic structures. The rectum is beneath the vagina, the bladder on top of it, and the uterus, bowel, and the rest of the abdominal contents are behind it. When the support between one of these structures and the vagina weakens, prolapse can occur. Risk factors for all types of prolaspe include childbirth, other pelvic trauma, connective tissue disorders, straining, and the aging process.
Symptoms include pelvic pressure or a sense of pelvic fullness, or a feeling that something is "falling out" of the vagina.
Types of Prolapse
Cystocele ("dropped bladder"): This occurs when the support between the vagina and the bladder weakens and the bladder bulges into the vagina. This type of prolapse can also be associated with urinary incontinence.
Rectocele: This is similar to a cystocele, but instead of the bladder, a portion of the rectum bulges into it.
Uterine Prolapse: This occurs when the ligaments that support the uterus weaken, causing the back wall of the uterus to "give way" allowing the uterus and cervix to move towards the front of the vagina.
Enterocele: This type of prolapse usually occurs in patients who have had a hysterectomy where the support of the pelvic ligaments has been disrupted. The small bowel, enclosed within a hernia sac, can protrude into the vagina.
Vaginal Vault Prolapse: This can also occur after a patient has had a hysterectomy. A vagina can be viewed as a pants pocket. The bottom of the pocket is the same as the back part of the vagina. If this back part of the vagina loses the architectural support from the pelvic ligaments, the vagina can "turn inside out" like a pants' pocket and bulge through the vaginal opening.
Diagnosis of the specific type of prolapse requires a careful pelvic examination. It is very difficult for patients to differentiate due to the similarities in symptoms and appearance of the various types of prolapse. There are many treatment options and these depend totally on the patient's wishes, degree of discomfort, and medical condition.
The possibilities are: observation alone, estrogen supplementation (strengthens the walls of the vagina), pessaries (devices which are placed into the vagina to prevent prolapse), and various vaginal or laparoscopy corrective procedures.