Surgeries to correct Pelvic Organ Prolapse (often referred to as POP) are among the most complex surgeries performed by gynecologists. The reasons for this are twofold. First, the support for the female pelvis is surprisingly multi-faceted. Second, everyone is different, so these procedures need to be carefully individualized to address each patient’s unique set of organ prolapse symptoms and problems.
Pelvic organ prolapse occurs in many forms and goes by a variety of names:
Uterine Prolapse: Uterine prolapse refers to a uterus that is dropping or sliding deep into the birth canal or even out of the body. If a person has previously had a hysterectomy, the top of the vagina (vaginal cuff) can still prolapse, much like a sock turning inside out.
Cystocele: Cystocele is the name given to a loss of support of the roof of the vagina that also provides support for the bladder. It is frequently called a “fallen bladder” or “prolapsed bladder”. These names, while descriptive, can be a little misleading in that the bladder itself is not actually exposed or visible. Rather, what is actually prolapsing is the vaginal skin that is supposed to provide a shelf of support for the bladder to rest on. If the bladder neck has also lost support, this is called an urethrocele. Loss of the support for the bladder neck can cause stress urinary incontinence (SUI), leading to leakage of urine with things like coughing, sneezing, laughing, jumping, exercise, lifting, or exertion.
Rectocele: Similar to a cystocele, if there is loss of support along the floor of the vagina between the vagina and the rectum, this is called a rectocele. If rectoceles are large enough, they can lead to difficulty with moving the bowels. A common complaint is that the person will say they have to push things back up or hold things in place in order to have bowel movements.
The most common symptom of all forms of pelvic organ prolapse is that the person feels a bulge or ball at or protruding beyond the opening of the birth canal. Straining or standing for long periods of time tends to make it worse. Some people will also experience pelvic pressure or a sensation of heaviness. Pain is not common but is occasionally present. Bleeding is rarely associated with pelvic organ prolapse and only occurs if there is ulceration of the skin that is being exposed. Urinary incontinence can be present if bladder neck support is compromised. Conversely, cystoceles can lead to incomplete emptying of the bladder and problems with frequent urinary tract infections. Similarly, rectoceles can interfere with bowel movements and defecation.
Surgery to correct pelvic organ prolapse must address each individual area of weakness in that person’s pelvic support. This means that the surgeon must have a thorough understanding of the pelvic anatomy and how the pelvic support is supposed to be provided. Only then can he or she accurately diagnose which areas of support are deficient and how best to correct them. Failure to correctly recognize all areas of weakness can lead to pelvic organ surgeries that don’t comprehensively address the problem and result in an early recurrence of the prolapse.
A variety of pelvic organ prolapse surgery options have been developed over the years to deal with the various aspects of pelvic organ prolapse. For example, to provide new support for the top (or apex) of the vagina, this can be done vaginally (sacrospinous ligament fixation), laparoscopically (utero-sacral vaginal vault suspension), or abdominally (sacral colpopexy). Moreover, because most patients have weaknesses in more than one area by the time their prolapse becomes symptomatic, they will need a combination of procedures which complement each other in order to fully recreate the pelvic support. Physicians who perform this surgery must understand this and know how to combine surgeries in order to achieve the desired result.
With over 25 years of experience, Dr Jones has performed thousands of surgeries for pelvic organ prolapse. If you are suffering from this problem or think you may have symptoms related to loss of pelvic support, it would be his pleasure to see you for a consultation.