Pelvic Organ Prolapse – FAQ & Links

Click on a question below for the answer:

Q

What does “prolapse” mean?

A
The word prolapse simply means displacement from the normal position. When this word is used to describe the female organs, it usually means bulging, sagging or falling. It can occur quickly, but usually happens over the course of many years. There are various types of prolapse, which can occur individually or together. The most common types of prolapse include cystocele, rectocele, uterine prolapse and enterocele.
Q

What symptoms are caused by my prolapse?

A
The symptoms depend on which type of prolapse you have. Since prolapse usually occurs slowly over time, the symptoms can be hard to recognize. Most women don’t seek treatment until they actually feel something protruding outside of their vagina. The very first signs can be subtle – such as pain during intercourse or an inability to keep a tampon inside the vagina. As the prolapse gets worse, some women complain of a bulging or heavy sensation in the vagina that worsens by the end of the day or during bowel movements. Some women with severe prolapse even have to push stool out of the rectum by placing their fingers into the vagina during bowel movements.
Q

Why did this happen to me? Did I do something to cause this problem?

A
The simple answer to this question is NO. There are many factors that seem to contribute to the development of prolapse, and almost none of them are things you can control. Genetics definitely plays a major role. Vaginal deliveries can predispose certain women to develop prolapse, but we haven’t learned how to identify these women BEFORE they have children. Other conditions that seem to go along with the development of prolapse are severe obesity, pelvic tumors and chronic constipation. Repetitive heavy lifting may contribute to prolapse as well.
Q

If I choose to use a pessary, won’t that give me an infection?

A
The ideal way to use a pessary is to insert it each day as part of your morning routine, and take it out for cleaning each night. When this is not possible, women come to the office about four to six times a year for an exam and pessary cleaning. Even when a pessary is worn almost continuously, vaginal infections are rare.
Q

If I decide to have surgery, what can I expect during the recovery period?

A
Most surgeries for prolapse are done vaginally with an epidural so there is very little pain and a fast recovery. Typically, an overnight stay and resting at home for 3-4 days is all the recovery needed and patients will be driving by the 5th day. Most women are voiding without problems after the surgery but 10% need a catheter to drain the bladder for 1-3 days. Limitation is lifting and varies between 2-6 weeks.
Q

If my surgery is successful, how long will it last?

A
The goal of continence or pelvic reconstructive surgery is to recreate normal anatomy permanently. However, none of these procedures are successful 100% of the time. According to the medical literature, failures occur in approximately 5 – 15% of women who have prolapse surgery. In these cases, it is usually a partial failure requiring no treatment, pessary use, or surgery that is much less extensive than the original surgery. Patients who follow our recommended restrictions for 12 weeks after surgery give themselves the best chance for permanent success.
Q

I have prolapse, but I don’t leak urine. Do I still need bladder testing?

A
Yes, if you are going to have surgery to correct the prolapse, bladder testing (called urodynamics) must be done first. That’s because the prolapsed portion of your vagina may be pushing on your urethra and preventing urine leakage. If that is the case, having the prolapse corrected can give you a new problem – urinary incontinence. The only way to tell whether a continence procedure is needed at the time of prolapse surgery is to perform urodynamics while holding the prolapse up in its normal position.
Q

How will my prolapse treatment affect my sex life?

A
If you choose to use a pessary, your sex life shouldn’t change, except for the fact that the pessary usually needs to be removed prior to intercourse. We recommend that you refrain from intercourse for 6-8 weeks after your surgery to allow proper healing. If you are post menopausal, estrogen vaginal cream will speed the healing. After resuming sexual activity, most patients report an improved sex life. If any problems are present, be sure to let Dr. Butrick know.

When prolapse is severe, one surgical option is to completely close the vagina. This procedure (called colpocleisis or colpectomy) is less invasive than reconstructive surgery, which makes it especially useful for patients with severe medical conditions. Of course, intercourse is impossible after having this procedure, so it is only appropriate for patients who are ABSOLUTELY sure that they never want to be sexually active again.

Q

How did you ever get interested in this field?

A
Treating prolapse and incontinence is challenging and very rewarding. Every patient has a unique set of symptoms, disorders and expectations, so we must individualize each treatment plan. Unlike most specialists, Urogynecologists have the opportunity to diagnose a condition; plan treatment based on the patient’s lifestyle and preferences; and follow up on the patient after treatment. It’s rewarding to see patients back after successful treatment, because they are usually very happy with their improved quality of life.

Also, we enjoy the challenge of improving patient care through medical research. Since our specialty is relatively new, there are many questions that still need to be answered through research studies.


Related Links

Our mission at the Urogynecology Center is to provide the highest level of care possible for women with incontinence, pelvic pain and/or pelvic organ prolapse. We provide this care in an individualized and highly compassionate manner, always keeping the needs of the patient in the forefront.


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