Pelvic Prolapse
Pelvic prolapse encompasses any type of prolapsing organ thru the vagina. The most common seen in urology would be the bladder “falling”, which is called a cystocele. Other types may include the rectum (rectocele), intestines (enterocele), or uterus (procidentia). A woman can have 1 or all these conditions at the same time. Women are more prone to these prolapses with number of pregnancy or prolonged increased abdominal pressure relation to chronic constipation, straining or lifting. Although not life threatening, these prolapses can cause bothersome symptoms such as urinary frequency, urinary retention, constipation, pelvic pain, bleeding, pain during sex, and other lower abdominal conditions.
Symptoms:
- Any bulge protruding from the vagina, especially while increasing abdominal pressure
- Pelvic pain/pressure
- Urinary changes- frequency, urgency, incontinence, retention/inability to urinate
- Pain during sex
- Constipation
- Painful bowel movements
- Sometimes- no symptoms
Risk Factors:
- Previous pregnancy/long labor/multiple vaginal deliveries
- Chronic constipation
- Previous pelvic surgery
- Hysterectomy (may predispose to bladder falling/cystocele)
- Chronic lifting/straining
- Chronic cough
Evaluation and diagnosis:
- Dr. Shaba will take a history and review your gynecologic records.
- Physical exam with pelvic exam will determine what is prolapsed
- Cystoscopy- a small camera placed into the bladder done in the office
- Imaging such as CT scan or ultrasound
- Bladder scan/post void residual
- Urinalysis and urine culture
Treatment:
If you have mild prolapse or it isn’t bothering you too much, sometimes the best treatment is no treatment.
Changing your habits (constipation, cough, lifting) can sometimes temper your symptoms and is good for long term even if you have surgery to prevent recurrence.
Most prolapses are fixed with surgery. There are many types of surgeries with mixed results depending on what you choose. There are high rates of reoccurrence of prolapse, so it’s best to discuss your cases with your doctor at length before jumping into surgery.
Pessary- this is a device that’s placed inside the vagina to hold what every organ is prolapsing back. Sometimes could be a good non-surgical option but also can be uncomfortable.
For more information please visit: https://www.urologyhealth.org/urology-a-z/b/bladder-prolapse-(cystocele)
