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Dr. Mary Dupont (top) and Dr. Eric Hurtado |
Once a topic that women were reluctant to discuss, pelvic organ prolapse is getting more attention as new surgical techniques are developed and utilized. Women who have experienced a diminished quality of life due to the symptoms of pelvic organ prolapse now have reason to hope. Dr. Mary Dupont and Dr. Eric Hurtado are urogynecologists who practice at
What is pelvic organ prolapse?
Dr. Dupont: Pelvic organ prolapse occurs when a pelvic organ drops from its normal position into the vaginal canal. As women age and their pelvic muscles get weaker, this is a common occurrence. In fact, by the age of 80, 10 percent of women will have undergone surgery to fix this condition.
Are there different types of prolapse?
Dr. Dupont: Yes, prolapse can occur in different areas: A cystocele is a prolapse of the bladder through the front vaginal wall; a uterine prolapse occurs when there is a weakness in the vaginal ceiling and the uterus drops into the vagina; a rectocele is a prolapse of the rectal wall, or the back wall of the vagina; and an enterocele is a prolapse of small bowel through the top of the vagina. A cystocele is the most common form of prolapse while an enterocele is more common after a hysterectomy.
What are the causes of pelvic organ prolapse and are some women at higher risk?
Dr. Dupont: Pelvic organ prolapse often occurs after childbirth, especially when women have had multiple vaginal deliveries or large babies. Difficult vaginal deliveries can weaken the muscles of the pelvic floor. Other risk factors include age, previous pelvic surgery, a hysterectomy, being overweight, chronic constipation or coughing, and pelvic organ tumors. Reduced levels of estrogen after menopause can further weaken vaginal support.
Dr. Hurtado: Some women may have a genetic predisposition to pelvic organ prolapse. Women who have weaker connective tissues appear to be at increased risk, and this risk factor tends to run in families.
At what age is pelvic organ prolapse typically diagnosed?
Dr. Hurtado: Pelvic organ prolapse is most often diagnosed in middle-aged and older women, typically those who are in their late 40s and older. While the damage occurs early on, it takes many years for the pelvic support structures to weaken and for problems to develop.
What are the symptoms of pelvic organ prolapse?
Dr. Dupont: The most common symptoms are the feeling of something coming down, vaginal discomfort, or a dragging ache in the pelvis. Women also complain of urinary incontinence, changes in voiding patterns, constipation, low back pain, and pain during intercourse. The degree of vaginal prolapse does not necessarily match the severity of symptoms that a woman may experience. Sometimes marked vaginal prolapse exists but the patient has no symptoms. Other women report quite severe symptoms although there may be only minimal prolapse.
How is pelvic organ prolapse diagnosed?
Dr. Dupont: Pelvic organ prolapse is diagnosed through a physical examination. Most women are able to describe the prolapse very well. Because many women aren’t even aware that they have a mild degree of prolapse, they tend not to complain about it until it has increased in severity.
Dr. Hurtado: In some patients with prolapse and difficulty passing bowel movements, an MRI can be ordered so that your physician can see how individual organs move, especially during straining maneuvers. However, the physical examination is the most important aspect to measure the type and stage of prolapse and to determine which areas need to have support restored.
What if I’m not ready to treat my pelvic organ prolapse?
Dr. Dupont: Assuming the prolapse is not causing significant problems, women can choose to leave things alone. With mild prolapse, Kegel exercises can be performed to help strengthen the pelvic floor muscles, and women can attempt to improve the conditions that are exacerbating the prolapse, such as losing weight, avoiding heavy lifting, and treating chronic coughs.
Dr. Hurtado: For some women, pelvic organ prolapse never limits quality of life, so no treatment is required. For others, the prolapse may get worse and these women may experience vaginal bleeding from ulcerations, urinary tract infections, or overdistention injuries of the bladder when the bladder doesn’t empty completely. In these cases, surgical intervention becomes a medical necessity. In the majority of cases, however, the decision to treat pelvic organ prolapse surgically is a quality-of-life decision.
What are the non-surgical treatment options for pelvic organ prolapse?
Dr. Hurtado: One option for the treatment of pelvic organ prolapse is observation. Many women prefer to begin with this option, especially if they are not experiencing problematic symptoms such as a bothersome vaginal bulge, difficult emptying the bladder, or frequent bladder infections.
Dr. Dupont: For those women who decide that some form of treatment is necessary, a pessary is a non-surgical treatment option. A pessary is a diaphragm-like device that can be placed inside the vagina to support the vaginal wall. Often the patient can manage (remove and clean) the pessary on her own; however, in some cases, a physician must manage the pessary. Typically, this requires visits to the doctor every six to 12 weeks. Just as a truss belt does not fix a groin hernia, a pessary doesn’t fix the problem of prolapse, but it improves symptoms for the patient by supporting the prolapsed organs. For women who wish to have more children, a pessary is often seen as a good temporary solution. A pessary may also be a good choice for older women, poor surgical candidates due to serious medical problems, and those who don’t have the necessary time to undergo a surgical procedure and recovery period.
What are the surgical treatment options?
Dr. Dupont: There are two different surgical techniques for the treatment of pelvic organ prolapse: Surgery can be performed vaginally or through the abdomen. Transvaginal surgery is the least invasive surgical approach because the surgery takes place through a natural orifice. Newer techniques that use synthetic mesh to support the repairs have dramatically reduced the recurrence rate for women who choose this procedure. In the hands of an experienced pelvic reconstructive surgeon, the procedure is safe, requires very little time in the OR, has minimal blood loss in most cases, and mild postoperative discomfort. Most women with prolapse are good candidates for transvaginal surgery.
Dr. Hurtado: Traditionally, an abdominal approach of using mesh called a sacral colpopexy has been performed with great efficacy and safety demonstrated in numerous clinical trials. This procedure can now be accomplished through a minimally invasive approach using a laparoscopic technique. This technique reduces the amount of blood loss, length of hospital stay, recovery time, and pain. Additionally, it has low rates of mesh exposure, painful intercourse, and reoperation.
How do I know if I’m a good candidate for surgery?
Dr. Hurtado: Whether or not you are a good candidate for surgery is a decision you will make with your physician. For patients who are considering surgery, it’s important to make sure that the physician you are consulting has specialized training in and experience with the particular procedure you wish to utilize.
How do I decide what type of surgery is best for me?
Dr. Hurtado: The patient’s decision is a very personal one and should take into account the type of prolapse the woman is experiencing (the anatomic problem), her medical history, the results she hopes to achieve, and her age. No one treatment fits all women. Your physician should tailor treatment to your individual situation. A thorough history, examination, and discussion of different options should be discussed prior to undergoing surgery. For example, an elderly or medically frail woman who may not be a good candidate for the surgeries described above may choose to have what’s called “obliterative surgery,” where the vagina is literally closed off rather than restoring normal anatomy.
Will surgery cure my pelvic organ prolapse?
Dr. Dupont: With the newer, minimally invasive surgical techniques, we have seen very high long-term success rates.
Dr. Hurtado: Surgery for pelvic organ prolapse can significantly improve a woman’s quality of life. We have been very successful at restoring and maintaining normal pelvic anatomy and support.
Can pelvic organ prolapse be prevented?
Dr. Dupont: Vaginal deliveries have higher associated rates of prolapse compared to cesarean deliveries. Other risk factors include chronic coughs, obesity, chronic constipation, tobacco abuse, chronic heavy lifting, reduced estrogen after menopause, and previous pelvic surgery. Kegel exercises can help stabilize a prolapse and reduce the chance that the condition will progress, particularly after childbirth. Kegel exercises help by strengthening the pelvic floor muscles. However, these exercises have not been found to be particularly helpful with severe cases of prolapse.
Dr. Hurtado: Avoiding chronic strain may also help prevent pelvic organ prolapse from occurring.
About Dr. Dupont:
Dr. Mary Dupont is a board-certified urologist who completed her medical school education at
Dr. Dupont’s private practice, Dupont Urology and Urogynecology, is located at
About Dr. Hurtado:
Dr. Eric Hurtado is board certified in obstetrics and gynecology and fellowship trained in urogynecology. He earned his medical degree from the George Washington University School of Medicine in
Dr. Hurtado practices with Mid-Atlantic Pelvic Surgery Associates at