Prolapse

Weakness or damage to the muscles and tissue in your pelvic floor can lead to urinary and pelvic organ prolapse, where your bladder, uterus, or other pelvic organ descends into your vaginal cavity. If you’re concerned about prolapse, make an appointment with Dr. Robert Gregory Owens at Advanced Pelvic Surgery — Southern Ohio’s premier pelvic floor rehab center — in West Chester, Ohio for expert diagnosis and treatment. With board certifications as both an OB/GYN and a female pelvic surgeon, Dr. Owens has over 20 years of experience in diagnosing and treating prolapse and goes out of his way to treat you like family, so you feel comfortable and confident in his care. Call to speak with his friendly staff or schedule an appointment online today.

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Support of the female pelvic floor can be modeled after a trampoline. The boney pelvis is the metal frame, the muscles are the springs, and the connective tissue (fascia) is the fabric. The trampoline can sag to the ground because the springs are stretched out, the fabric is stretched or torn, or a combination of the two.

Physical therapy can help improve the muscles (springs), while surgery addresses the stretched or torn connective tissue (fabric). The two approaches compliment each other in gyn surgery the same way they do in orthopedics.

Viewed from the top female pelvic support can be modeled by a wagon wheel. Again the pelvis is the metal rim. And the center hub is where the uterus sits. The center hub is supported from the rim by the spokes which represent the bladder and rectum support. When viewed from the side, think of a suburban mailbox. The mail door is the vaginal opening and the inside is the vaginal canal. The upper side facing the sky is the bladder support, and the opposite side facing the ground is the rectum support. The very back of the mailbox would be the apex support for the uterus or the vaginal cuff if one has had a hysterectomy.

Organs will prolapse (fall out) when there is a loss of support (damage to the connective tissue) in the face of either gravity or or an increase in abdominal pressure with exertion. Prolapse is typically worse later in the day after being active, and better first thing in the morning after lying down all night. Symptoms can range from pelvic heaviness or pressure, to subtle discomfort with intercourse to tissue actually buldging past the vaginal opening.

A fallen bladder is called a cystocele. There are two basic types. The first is where the supporting connective tissue (fabric) has been stretched out and allows the bladder to push directly against the vaginal mucosa. The second type is where the connective tissue has torn, either where it attaches to the pelvis called a paravaginal defect, or from the top of the vagina or cervix. Both the bladder and the vagina are made to be stretched so neither one will hold the other in once the supporting tissues have been damaged.

A rectocele occurs when the supporting tissue between the rectum and vagina is compromised. These are a common occurrence as this area takes a beating with childbirth. Difficulties with having a bowel movement can occur with rectocele. When the rectocele bulges far enough out it acts as a reservoir to collect the stool with a bowel movement. The stool follows the path of least resistance which is into the pouch rather than out of the anus. Women will independently discover that they can help themselves have a bowel movement by pressing on the rectocele while they go. This eliminates the reservoir and facilitates normal function. Uterine prolapse occurs when the supporting ring at the top of the vagina is damaged. Follow this link to learn more: https://www.augs.org/assets/2/6/POP.pdf

Pelvic Pain Q & A

What is pelvic prolapse?

Pelvic prolapse is a condition where one of the organs in your pelvic area doesn’t receive sufficient support and descends in your vaginal cavity. This condition can be painful, disrupt your urinary and bowel function, and make sex uncomfortable.

There are different kinds of pelvic prolapse:

Uterine prolapse - Uterine prolapse occurs when your uterus descends into your vaginal cavity because of damage or weakness in the supporting ring at the top of your vagina.

Cystocele - A cystocele, also known as a fallen bladder, is when your bladder receives insufficient support from your cervix or the supporting connective tissue in your pelvic region. Your bladder either pushes against your vaginal mucosa or, if there’s a tear in the connective tissue, pushes into your vaginal cavity.

Rectocele - A rectocele develops when weakness in the thin tissue that separates your vagina and your rectum allows your rectum to push into your vaginal cavity.

Enterocele - An enterocele is a vaginal hernia where damage or weakness in the tissues between your uterus and rectum allows part of your small intestine to push through into your vaginal canal.

What causes pelvic prolapse?

Pelvic prolapse occurs when damage or weakness to the muscles and tissues doesn’t provide enough support to the organs in your pelvic area, and they descend or push through the weak tissue to rest in areas where they don’t belong.

Various conditions contribute to pelvic floor weakness. For example, the physical stress of pregnancy and vaginal childbirth can stretch and weaken your pelvic floor. Additionally, vaginal atrophy, a condition caused by decreased estrogen levels due to menopause or chemotherapy, can make the walls of your vagina thin, dry, weak, and susceptible to tearing.

How’s prolapse treated?

Non surgical treatment of prolapse is with supportive devices called pessaries. These are made of silicone rubber and fit into the vagina to act as a sort of doorstop to hold things up. Once properly fitted you will not know that it is in. Depending on the type you can remove and place the pessary as you wish or get one where the doctor will remove and clean it at intervals so you don't have to. For more information, click here: https://www.augs.org/assets/2/6/Vaginal_Pessaries_Large_Print.pdf

Surgical treatment of prolapse consists of repairing and reattaching torn or damaged connective tissues to establish normal pelvic support so that normal pelvic function follows. For more information about prolapse repair, click here. For more information about robotic prolapse repair, click here.

Dr. Owens takes time to talk to you about your condition, listen to your concerns, and answer your questions. He wants to make sure you feel comfortable with your treatment plan and offers a combination of functional rehab and traditional medicine and surgery.

Can I do anything to prevent prolapse?

You can practice Kegel exercises regularly to strengthen your pelvic floor. Scheduling regular well-woman visits and pelvic exams with Dr. Owens is also critical. Then, if you begin to show signs of prolapse, he can treat the issue quickly before it disrupts your life.

If you’re concerned about prolapse, call or schedule an appointment online at Advanced Pelvic Surgery today.