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Pelvic Organ Prolapse

Baylor Scott & White Center for Reconstructive Urology

About pelvic organ prolapse

Pelvic Organ Prolapse (POP) is a downward descent of the female pelvic organs, including the bladder, rectum, uterus if present, upper part of the vagina if the uterus is absent or small bowel resulting in a bulge pressing into or out of the vagina.

Prolapse development can be attributed to the damage, stretching and weakening of the support muscles and ligaments in the female pelvis. These support structures keep the bladder, rectum, small bowel and uterus oriented in the appropriate position. Any event that results in damage to these structures can result in POP.

Factors contributing to pelvic organ prolapse include:

  • Child birth
  • Hysterectomy
  • Pelvic trauma
  • Aging
  • Straining (heavy lifting, defecation, chronic coughing)
  • Prior surgery for POP

Symptoms of pelvic organ prolapse

  • Bulge in the vagina or protruding out of the vagina
  • Pelvic pressure
  • Dolor lumbar
  • Urinary problems (slow stream, urinary incontinence, urinary frequency)
  • Bowel problems (constipation, fecal incontinence)
  • Painful intercourse

Types of pelvic organ prolapse

  • Cystocele: Also known as "dropped or fallen bladder," it is the protrusion of the bladder through the front wall of the vagina.
  • Rectocele: When the rectum protrudes through the back wall of the vagina.
  • Enterocele: When the small bowel protrudes through the upper portion of the vaginal wall.
  • Uterine Prolapse: When the uterus protrudes downward into or out of the vagina.
  • Vaginal Vault Prolapse: Where the upper part of the vagina turns itself inside out and protrudes into or out of the vagina. This occurs if the uterus is absent.

Diagnosing pelvic organ prolapse

The diagnosis of POP does not require special diagnostic tests or procedures. A thorough history from the patient as to her symptoms and what activities exacerbate her condition and what maneuvers help relieve it is the first step in the evaluation.

Dr. Secrest then performs a brief physical exam with the emphasis on the pelvis. It is very difficult for the patient to distinguish one form of prolapse from another they simply notice they have developed a bulge in the vaginal area associated with some discomfort.

Treatment options for pelvic organ prolapse 

Either nonsurgical or surgical treatments should be made based on the following factors:

  • The severity of the prolapse
  • How much of a negative impact the prolapse has on the patients life style
  • The overall health of the patient
  • Your consultation with your physician as how much benefit you can expect from your treatment choice.
  • Although age needs to be factored into a patients choice of treatment it should not be a deterrent to seeking help. The majority of 70 and 80 year old individuals are much more healthy and active than that age group was 20 years ago.

Non‐surgical treatments

  • Lifestyle changes: diet, weight loss, smoking cessation
  • Pelvic floor therapy: Best result are obtained by working with a physical therapists trained in the pelvic floor rehabilitation
  • Pessaries: a removable device placed into the vagina to provided support to the pelvic organs surrounding the vagina

Surgical treatments

Advancement in surgical techniques, instruments and synthetic grafts have transformed the surgical treatment of pelvic organ prolapse from a very invasive procedure associated with high failure rates to a minimally invasive highly successful form of treatment.

The surgical procedures performed now are designed to replace the damaged muscles, tendons and ligaments in the female pelvis.

According to Charles Secrest, MD, "I have performed thousands of slings and prolapse repairs over the last 25 years including 850 slings using the Suspend fascial grafts, and over 360 pelvic organ prolapse reconstruction procedures using the Axis dermis. 

This is accomplished by the philosophy I have had for a long time, that it is better to repair the vagina by going through the vagina, not the abdomen. I designed an approach to repair cystoceles and other forms of pelvic organ prolapse in 1995 and began using various materials to correct the defects in the pelvic floor. The idea behind these repairs was to use a material to support and reconstruct the weakened pelvic floor, much like placing the bladder, rectum, or intestines in a hammock. The problem was that many of the materials that I used early on were not predictable and thus some of the repairs failed. Mesh kits became available in the early 2000s, and I implanted these grafts in over 200 patients. This was a very similar technique compared to my original design; however, some of the patients complained of a stiff vagina, and therefore I kept looking for a better product. I had no serious complications from the mesh kits. In fact, there was only a 1.5% incidence of minor exposures of the mesh, but I knew we could find a better graft material. I had been using cadaveric fascia lata grafts (Suspend) for slings for many years, and I approached the company looking for a suitable graft for POP. What we came up with was a graft made of cadaveric dermis (Axis). This is an acellular, soft but thick graft material that is taken from the skin of a tissue donor. The graft is prepared using a technique called Tutoplast, which is 31-step process using hypertonic saline that renders the graft sterile, denatures the DNA, yet leaves the collagen in tact. The cells in the patient's body grow into this graft which serves as a scaffolding for tissue remodeling, thus forming the strong hammock that I was looking for. There have been over 2 million of these types of grafts implanted worldwide without an infection or a rejection of this material. This graft is not encapsulated, but incorporated into the patient's tissues forming a very strong platform on which the pelvic organs can rest. I have been using this approach and this graft material now, since 2003, and have used it exclusively since moving to Longview in 2013."

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