What is Vaginal Prolapse Relaxation?
Vaginal prolapse (also called pelvic organ prolapse, or vaginal
organ prolapse) is what happens when organs inside the pelvis
fall, bulge or protrude into the vaginal wall. This condition
is due to weakened muscles or ligaments that can occur from
a number of causes, including childbirth, previous surgeries,
and obesity. If you have signs and symptoms of vaginal prolapse,
learning more about this condition (and discovering you have
options) can lead to a better way of life.
Forty percent of women aged 40 to 79 are affected by vaginal
prolapse and by age 80, more than one out of every 10 women
will have undergone surgery for prolapse or urinary incontinence.
Vaginal prolapse can affect a woman's daily life, limiting physical
activity and sexual intimacy. Each year approximately 200,000
inpatient procedures are performed in the US to correct this
Prolapse is caused by muscles and ligaments that have been
weakened or damaged. The most common causes of prolapse include:
Often, the stresses and strains of childbirth
(especially multiple, large, or difficult childbirth) can weaken
or damage pelvic muscles and ligaments, and eventually, causes
Surgeries, especially in the pelvic area,
may affect your muscles and other supportive tissue, potentially
leading to vaginal prolapse.
Because important, supportive ligaments may
be removed during your surgery, you may face an increased risk
of prolapse after hysterectomy (vaginal vault prolapse).
Added weight can strain muscles in the pelvic area,
and over time, this can weaken muscles, which can lead to vaginal
Because aging can weaken pelvic muscles and ligaments,
the risk of vaginal prolapse increases – in fact, it doubles
with each decade of life – and affects half of women over
Studies suggest that vaginal prolapse may occur
more often in women of Northern European descent, and less frequently
in women of African-American descent. Hispanic and Asian women
may have an increased risk of developing cystocele (a form of
Research suggests vaginal prolapse may also run
in families–a women with a mother or sister who has had
a prolapse may be more likely to develop prolapse.
Women who experience repetitive straining, such as
with chronic constipation, or with jobs that involve heavy lifting,
may be at an increased risk for vaginal prolapse. In addition
menopause may also be a factor in the onset of prolapse.
Types of Prolapse:
Vaginal Vault Prolapse
The bladder and urethra are supported by the anterior or upper
vaginal wall. When there is a break in the support of the anterior
vaginal wall, the bladder and urethra fall, resulting in a
Loss of support at the level of the urethra. Can be diagnosed
by doing a Q-tip test and often accompanies stress urinary
A common condition where there is a loss of support of both the urethra and bladder where the bladder bulges into the vagina.
A rectocele occurs when the thin wall of fibrous tissue (fascia)
separating the rectum from the vagina becomes weakened, allowing
the front wall of the rectum to bulge into the vagina.
Childbirth and other processes that put pressure on the fascia
can lead to a rectocele. A small rectocele may cause no signs
or symptoms. If a rectocele is large, it may create a noticeable
bulge of tissue through the vaginal opening.
Though this bulge may be uncomfortable, it's rarely painful.
When treatment of a rectocele is necessary, self-care measures
and other nonsurgical options are often effective. In severe
cases, you may need surgical repair.
Childbirth and aging may weaken the muscles and ligaments (pelvic
floor) that support your bladder, uterus, colon and small intestine.
The weakening may cause one or more of these organs to drop
(prolapse). One resulting condition is an enterocele. For a
mild or moderate enterocele, nonsurgical treatments — particularly,
exercises to strengthen your pelvic floor muscles — may
symptoms. More severe cases of enterocele may require surgical
Uterine prolapse occurs when pelvic floor muscles and ligaments
stretch and weaken, providing inadequate support for the uterus.
The uterus then descends into the vaginal canal.
Uterine prolapse often affects postmenopausal women who've had
one or more vaginal deliveries. Damage to supportive tissues
during pregnancy and childbirth, effects of gravity, loss of
estrogen, and repeated straining over the years all can weaken
your pelvic floor and lead to uterine prolapse.
If you have mild uterine prolapse, treatment usually isn't needed.
But if uterine prolapse makes you uncomfortable or disrupts
your normal life, you might benefit from treatment. Options
include using a supportive device (pessary) inserted into your
vagina or having surgery to repair the prolapse.
Vaginal Vault Prolapse
Vaginal vault prolapse occurs when the upper portion of the
vagina loses its normal shape and sags or drops down into the
vaginal canal or outside of the vagina. It may occur alone or
along with prolapse of the bladder (cystocele), urethra (urethrocele),
rectum (rectocele), or small bowel (enterocele). Vaginal vault
prolapse is usually caused by weakness of the pelvic and vaginal
tissues and muscles. It happens most in women who have had their
uterus removed (hysterectomy).
Symptoms of vaginal vault prolapse include:
- Pelvic heaviness
- A mass bulging into the vaginal canal or out of the vagina that
may make standing and walking difficult
- Involuntary release of urine (incontinence)
- Vaginal bleeding
During surgery, the top of the vagina is attached to the lower
abdominal wall, the lower back (lumbar) spine, or the ligaments
of the pelvis. Vaginal vault prolapse is usually repaired through
the vagina or an abdominal incision and may involve use of either
your tissue or artificial material.
- Incision-less mesh
- Pelvic floor mesh repair systems: Apogee, Peregee, Prolift ,
Avulta, Pinnacle, Uphold, Prolift M, Elevate, Prosima
- Sacrospinal Ligament Suspension
- Uterosacral Ligament Suspension
- McCull Culdoplasty
Also known as a uterine prolapse pessary, this is a device that
is placed into the vagina to provide support to the related
pelvic structures and relieve pressure on the bowel and bladder.
These devises may be a ring or a donut shape, or a ring with
support. They are usually made of silicone and fitted by a
Pessaries are usually used with patients who decline surgery,
who may be poor candidates for surgery, or who need temporary
relief of pregnancy related prolapse or incontinence.
Prolapse surgery is used to repair and reconstruct the support
of the vagina and its neighboring organs when there is a prolapsed
uterus. The surgeon's goal is to restore normal anatomy, sexual
function and human physiologic function (urinating and defecating).
Since uterine prolapse is not life threatening, surgery is indicated
only if the patient feels that her condition is severe enough
that it warrants correction. Mild prolapse need not be surgically
corrected for it is rarely symptomatic.
Surgical options for patients with uterine and/or vaginal
prolapse is dependent upon:
- Degree or severity of prolapse
- Areas specific for prolapse
- Desire to maintain fertility (maintain uterus)
- Desire to maintain sexual function
- Patients age
- Patients overall general health
- Patients desire and opinion
Vaginal Acces Corrective Procedures
Many doctors now use mesh as a vaginal prolapse treatment. These
mesh repairs may be as effective as traditional surgical procedures,
while smaller incisions potentially minimize pain and recovery
Depending on your needs and the procedure performed, your
doctor may be able to choose a graft made from either a synthetic
mesh or a biologic mesh to repair the prolapse and restore your
Typically, these minimally invasive prolapse treatment procedures
take place on an inpatient basis and are performed under general
Minimally invasive mesh repair procedures generally follow
- A vaginal incision and a few small skin incisions are made.
You may either have an incision at the crease where your upper
thigh meets your buttocks or in the middle of your buttocks
on both sides.
- The mesh is inserted through an incision, placed in the body,
secured with stitches, and the incisions are closed.
The use of mesh in surgical procedures is not new, and is
commonly used. Mesh used for vaginal prolapse surgery is light,
soft, porous, and pliable, allowing your own body's tissues
to grow in and around it. Once placed, you should not feel the
mesh inside you.
Examples of these types of procedures include:
Pelvic floor repair mesh systems
Straps of graft material are placed between the vagina and bladder
and/or rectum, to provide additional support for a cystocele
(bladder) or rectocele (rectum) repair. These straps are also
attached to ligaments or muscles to provide support to the
top of the vagina. The graft material can be made from human
tissue, but most are now made out of a permanent material called
polypropylene mesh. The mesh is usually placed through 1-2
inch incisions along the front and back walls of the vagina.
Additional tiny incisions may be required near the groin and
buttocks to anchor the graft.
Pelvic floor repair mesh systems
Laparoscopic or DaVinci Robotic sacral colpopexy
Sacral colpopexy is a current gold standard of care for treatments
of pelvic organ prolaps that is most proven as durable and anatomically
correct repair. Underutilization of this technique comes mostly
from invasivness of abdominal approach and lack of surgeons
training and experience with this advanced technique. Incorporation
of this time proven procedure with minimally invasive approach
of laparoscopy, robotic surgery or sils results in superb, durable,
anatomically correct repairs in experienced hands of a surgeon
familiar with advanced laparoscopic technique. Laparoscopic,
robotic and SILS sacralcolpopexy provides for most patient satisfaction,
especially for younger sexually active women where caution must
be exercised if pelvic floor meshes are to be employed.
Sacrocolpopexy is a procedure to surgically correct vaginal
vault prolapse where mesh is used to hold the vagina in the
correct anatomical position. This procedure can also be performed
following a hysterectomy to treat uterine prolapse to provide
long-term support of the vagina or to provide support for the
da Vinci Sacrocolpopexy uses a state-of-the-art surgical system
designed to help your surgeon perform a minimally invasive surgery
through small 5-8mm or ¼ of an inch incisions.
SILS sacral colpopexy is performed through the belly button
only. This surgically most advanced technique has superior cosmetic
outcomes leaving virtually no scaring on the abdomen. Less incision
equals less pain, less wound healing complications, less potential
For most women, Laparoscopic, da Vinci or SILS Sacrocolpopexy
offers numerous potential benefits over a traditional open approach:
- Significantly less pain
- Less blood loss and need for transfusions
- Less risk of infection
- Less scarring
- Less risk of ventral hernias
- Shorter or no hospital stay
- Shorter recovery time
- Quicker return to normal activities
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