Pelvic organ prolapse

• A feeling of pressure or fullness in the pelvic area.
• A backache low in the back.
• Painful intercourse.
• A feeling that something is falling out of the vagina.
• Urinary problems such as leaking of urine or a chronic urge to urinate.
• Constipation or loss of bowel control.
• Vaginal bleeding

Anything that puts increased pressure in the abdomen can lead to pelvic organ prolapse. Common causes include:

• Pregnancy, labor, and childbirth (the most common causes)
• Obesity
• Respiratory problems with a chronic, long-term cough
• Constipation
• Pelvic organ cancers
• Surgical removal of the uterus (hysterectomy)

Prolapse ranges in severity from very mild (i.e., prolapse that can only be felt by your doctor on examination) to severe (where one or more of the pelvic organs actually protrude through the vaginal opening). A severe prolapse looks like a red ball protruding from the vagina.

The four categories of uterine prolapse are:

• Stage I – the uterus is in the upper half of the vagina.
• Stage II – the uterus has descended nearly to the opening of the vagina.
• Stage III – the uterus protrudes out of the vagina.
• Stage IV – the uterus is completely out of the vagina.

The more advanced the stage of prolapse is, the less likely it is to respond to conservative management.

The bladder (which stores urine), urethra (which carries urine to outside the body), and rectum (muscle that controls bowel movements) may bulge out with the uterus. An untreated prolapse can cause sores on the cervix (opening to the uterus) and increase chances of infection or injury to other pelvic organs.

In the past, many forms of exercise were considered ‘unsafe’ and not recommended for women with prolapse. We know that low impact exercise is safe for all women who have a prolapse, regardless of the strength of their pelvic floor muscles. Some examples include:

• Walking
• Swimming
• Seated cycling
• Low intensity water aerobics
• Low impact exercise classes
• Seated light weights
• Narrow squats and lunges

Do not do activities that put pressure on your pelvic muscles. This includes heavy lifting and straining. Try exercises to tighten and strengthen your pelvic muscles. These are called Kegel exercises.

Consider surgery if the prolapse is causing pain, if you are having problems with your bladder and bowels, or if the prolapse is making it hard for you to do activities you enjoy.

Regardless of the route, the sacrocolpopexy procedure is the same. Your surgeon attaches the top of the vagina to a strong ligament (connective tissue) along the sacral spine (between your lower back and tailbone) using a synthetic mesh.

No, it is a laparoscopic/robotic operation. This allows the patient to have a faster recovery and reduce hospital stay.

Even if your surgery is done through a less invasive way, surgeries to repair prolapse tend to be major surgery.

Usually the graft is anchored to the muscles of the pelvic floor. Generally this surgery is not very painful. You may feel as if you have been ‘riding on a horseback’. You will have some discomfort and pain,which is easily controlled with painkillers.

Most women feel better within the first week following surgery; however, do not lift, push or pull any heavy objects until after your doctor says it is OK. Full recovery takes six weeks to allow for internal healing.

Success rates for posterior repair are 80-90%, however there is a chance that the prolapse may recur or another part of the vaginal wall may prolapse.