Woman holding her legs in pain on the bed.

Pelvic Organ Prolapse

Pelvic organ prolapse is a condition in which our pelvic organs such as the uterus, vagina, bowel or bladder start bulging or falling out of the vagina. The bladder pushes on the front wall of the vagina and the bowel pushes onto the back wall of vagina. It is caused by the weakening of  the muscles, ligaments, and fascia, which support the tissues that hold those organs in place and in the correct positions.

Causes

  • Childbirth
  • Obesity or weight gain
  • Smoking
  • Menopause
  • Chronic cough
  • Having a hysterectomy
  • Chronic constipation
  • Heavy lifting or straining
  • Aging

These may cause prolapse and some women may have inherited the risk of prolapse because of their collagen structure.

Symptoms

  • Pressure against the vaginal wall
  • A fullness feeling or “a ball” feeling in the stomach area
  • Backache
  • A pull or stretch feeling in your groin area
  • Painful intercourse
  • Problems passing urine
  • Constipation

Surgery for pelvic organ prolapse is performed to restore their anatomy and would include different types of procedures depending on the type of prolapse and the stage of prolapse that the patient is experiencing. 

Pre-procedure preparation for the surgery would include: not eating for six hours before the surgery, arriving on the day of the operation to the hospital where you will get admitted to the ward and have an anaesthetic assessment. 

We do not perform surgery on the same day of the consultation as we have to book the procedure into our operating rooms. Surgery is usually performed under general anaesthesia and occasionally under spinal anaesthesia. Surgery may take anything between an hour to two hours. There is no pain during the operation as the patient is asleep. After the procedure, the woman usually stays in the hospital for about two to three days, and we suggest four weeks off of work. Pain levels are moderate and controlled with various intravenous medications that we use immediately afterwards, for about 24 hours and tablets thereafter. 

Most of the surgery does not leave scars as we perform it through the vagina, so it will be only one scar on the top of the vagina that you cannot see and cannot feel. On occasions, we perform pelvic organ prolapse surgery through a keyhole surgery or laparoscopy. That would leave small scars on the tummy. 

Recovery is about four to six weeks and you will know whether the treatment worked or not once you have recovered. The success rate of vaginal pelvic floor repair is about 70 – 80 and laparoscopic is about 80%.

There is a possibility of the symptoms returning in 5-10 years time. The surgery cost will depend on the operation. This is something that will be covered by medical aid, especially a hospital fee. You may, however, have outstanding fees for the surgeons and an anaesthetist fee; depending on your level of medical aid cover. 

While there is a different way of treating organ prolapse, we normally start with non-surgical treatments such as pelvic floor exercises. 

Pelvic floor exercises can be an effective treatment for women with a mild prolapse. 

Pelvic floor exercises will not fix severe prolapse, but they’re important in maintaining strength in the pelvic floor. The most appropriate way of doing pelvic floor exercises is by seeing a pelvic floor therapist or physiotherapist who would teach you to do it correctly. I usually give my patients an approach that describes how it’s done. 

Elderly women may not be good candidates for surgeries because of their age and their comorbidities and they are often happy to use a pessary for the treatment of pelvic floor prolapse. The pessary is a rubber ring that is inserted in the vagina by a doctor and it holds the organs that have fallen out of place. 

It’s a very nice treatment for my elderly women and women who would like to have surgery, but have to wait for whatever reason. The inconvenience of using a pessary is an increased amount of vaginal discharge and having to see me every three months to change the pessary. However, the pessary can be done on the day of the consultation as it is a quick procedure to insert it and it doesn’t require anaesthesia. We just have to choose the correct size of the pessary and once it is in place, we have to make sure that the patient is able to pass urine afterwards. 

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