When the support of the uterus or vagina weakens, the uterus or vaginal walls can collapse causing a feeling of pressure or bulge. Many women will see or feel something protruding through the opening of the vagina. This can be the walls of the vagina or the uterus. Common words women use include fallen bladder, bladder prolapse, uterine prolapse, cystocele, or rectocele.
Pelvic floor exercises will decrease the symptoms and even prevent it from worsening in the case of mild prolapse. Nurses and physical therapist can use biofeedback to train women to use their pelvic floor muscles correctly.
Vaginal inserts called pessaries treat prolapse symptoms by holding the fallen uterus or vagina in place so the symptoms are less bothersome. Some women choose to use pessaries temporarily and others will use them for many years.
Surgery may be the right option for many women.
Many surgeries may be recommended for prolapse in general, but they fall into two main categories.
Vaginal surgery. This type of surgery requires no incisions on the abdomen. The surgeon uses stitches (sutures) to repair the weakened walls of the vagina to support the bladder or rectum. The top of the vagina may also be suspended to reposition it back inside the pelvis. These surgeries do not use surgical meshes. Many times these surgeries are referred to as "native tissue" surgeries, meaning no mesh.
Robotic surgery. In robotic surgery, the surgeon uses a robotic to operate inside the abdomen without requiring a large incision. Each incision measures less than 1 cm or less than the width of your pinky fingernail. The most common type of prolapse repair done robotically has the highest long term success rate of all prolapse repairs. Sacrocolpopexy was developed in the 1970's and over the years has become the gold standard for prolapse repairs. It is uncommon for women to experience a recurrence of their prolapse after this type of repair. A surgical mesh is used for this type of repair which is what gives the surgery the durability and the high success rate. This surgery is not related to the "vaginal mesh" surgeries that can be seen on the commercials by many law firms. Those mesh based surgeries for prolapse are no longer on the market.
Surgeries for prolapse and incontinence have become outpatient surgeries as healthcare has improved. Some patients may stay overnight, but many go home the same day.
Every patient's experience will be different but there are some basic expectations.
The day of the prolapse procedure, women are generally able to walk, do normal daily activities and take care of themselves. Although tub baths are discouraged, women may shower even the day of the surgery. Over the first 6 weeks, heavy lifting and straining could cause pain or even put pressure on the incisions that could cause problems. Usually by 2-3 weeks, most women will be back to typical daily activities but will still have some level of surgical tenderness that will require them to limit some activities. As would be expected with any surgery, each week things improve and by the time patients reach the 6 week mark, they are usually ready to get back to regular exercise, intercourse, and returning to unrestricted activities.
Every woman has different goals and expectations. So depending on the conversation between her and the physician, a treatment plan personalized to the individual will be established to best meet those goals and expectations. Most of the time, a variety of surgeries will be combined to meet the individual needs of the patient.