Pelvic Relaxation & Pelvic Organ Prolapse

What is pelvic relaxation?

Pelvic relaxation is the weakening of the pelvic floor muscles that support the vagina, bladder and uterus. This weakening can lead to pelvic organ prolapse.

Who is at risk for pelvic relaxation?

The most common risk factor for pelvic relaxation is childbirth.

How is pelvic relaxation treated?

Pelvic relaxation can be treated by:

• Pelvic floor physical therapy
• Biofeedback – a technique that measures the electrical activity in your pelvic floor muscles to show you if you are tightening or relaxing your muscles properly. This allows you to see and “retrain” your pelvic floor muscle movement.
• Surgery – if non-surgical treatments are not enough, your doctor may recommend surgery to restore your organs to their original positions. This can be done laparoscopically, a minimally invasive surgical technique.

What is pelvic organ prolapse?

Pelvic organ prolapse is a condition where weakened pelvic floor muscles cause one or more organs to sag. In severe cases, one or more of these organs can bulge into another organ or sag outside of your body.

The type of prolapse you have will depend on the location of your pelvic floor weakness and which organs are affected. Common types of pelvic organ prolapse include:

• Cystocele (prolapse of the bladder)
• Rectal prolapse
• Uterine prolapse
• Vaginal prolapse

Who is at risk for pelvic organ prolapse?

Postmenopausal women, women who have given birth vaginally and women who have experienced previous vagina surgeries, are at increased risk of uterine prolapse.

How is pelvic organ prolapse diagnosed?

To determine if pelvic organ prolapse is the cause of your symptoms, your doctor will perform a thorough pelvic examination to check the position of your uterus and assess the degree of the prolapse and the strength of your pelvic floor muscles.

How is pelvic organ prolapse treated?

Your treatment will depend on the degree of prolapse, as well as your overall health and lifestyle. Treatment options for pelvic organ prolapse include:

• Kegel exercises to improve pelvic floor muscle tone, since over time you may continue to lose tone, making the prolapse more severe.
• Weight loss or weight maintenance to minimize the stress on the pelvic floor.
• Pelvic floor physical therapy to improve the condition of your pelvic structures.
• A vaginal pessary, which is a removable device that fits inside the vagina and helps to hold the uterus in place.
• Estrogen replacement therapy, which may help to limit further weakening of the pelvic floor muscles and other supportive connective tissues.
• Surgery, including minimally invasive laparoscopic techniques and robotic-assisted surgery utilizing the state-of-the-art da Vinci® Surgical System.

What is cystocele (prolapse of the bladder)?

Prolapse of the bladder, also known as cystocele, occurs when the ligaments and muscles that hold up your bladder stretch or weaken. It can lead to difficulty urinating, urinary incontinence and pain when inserting a tampon or having sex.

What are the symptoms of cystocele?

Symptoms of cystocele include:

• Feeling something bulging through your vaginal opening.
• A feeling of fullness, heaviness or pain in your pelvic area.
• Urinating more than usual.
• Urinary incontinence.
• Difficulty fully emptying your bladder.
• Frequent urinary tract infections (UTIs).
• Difficulty or pain when inserting tampons or menstrual cups or when having sex.

How is cystocele diagnosed?

Your Hoag doctor can diagnose cystocele using a physical examination and through tests, such as:

• Urodynamic testing, which measures your bladder’s ability to hold and release pee.
• Cystoscopy, a test involving inserting a long, pencil-sized lighted tube with a camera on the end through your urethra to your bladder. Your doctor will use this scope to look for malformations, blockages, tumors or stones in your urinary tract.

How is cystocele treated?

Cystocele can be treated with:

• Lifestyle adjustments, such as weight loss
• Estrogen replacement therapy
• Pelvic floor therapy or exercises, such as Kegel exercises.
• A vaginal pessary device.
• Surgery to tighten the muscles that hold your bladder in place.

What is rectal prolapse?

Rectal prolapse is a condition that occurs when the muscles that hold up your rectum, part of your large intestines, weaken. Rectal prolapse can be mistaken for hemorrhoids, but they don’t go away on their own.

How is rectal prolapse diagnosed?

A physical examination will be needed to diagnose rectal prolapse. Additional tests could include:

• Digital Rectal Exam, using lubricated gloved fingers.
• MR Defecography, an imaging study of your rectal muscles using an MRI.
• Anorectal Manometry, which measures the strength and tightness of your anal sphincters.
• Lower GI Series (barium enema), video X-rays of your lower gastrointestinal tract.
• Colonoscopy, an examination of your large intestine using a flexible scope.
• Electromyography (EMG), a test to look out for nerve damage muscle coordination.

How is rectal prolapse treated?

Surgery is usually required to treat rectal prolapse. Your physician can determine the best surgical team for your condition.

What is uterine prolapse?

Uterine prolapse is a condition in which the muscles and tissues around your uterus become weak, causing your uterus to sag or drop down into your vagina.

Women with mild cases of pelvic organ prolapse may not experience any symptoms. However, as the uterus slips further out of position, it can place pressure on other pelvic organs causing a variety of symptoms, such as:

• Heaviness
• Pain or pressure in the pelvis
• Pain during intercourse
• Urinary incontinence
• Frequency or urgency
• Recurrent bladder infections
• Lower back pain

Who is at risk of developing uterine prolapse?

Uterine prolapse is a common condition, but women who are postmenopausal or who have had more than one vaginal delivery are at highest risk.

How is uterine prolapse diagnosed?

Your doctor will perform a pelvic examination to determine if your uterus has lowered from its normal position.

How is uterine prolapse treated?

For moderate to severe cases of pelvic organ prolapse, the most effective treatment option and “gold standard of care” is sacrocolpopexy. This option uses a surgical mesh to hold the uterus in place.

Hoag offers the more precise and less-invasive robotic-assisted sacrocolpopexy, which allows surgeons to more clearly view the pelvic structures using 3D technology. Robotic-assisted surgery provides many benefits to patients, including less postoperative pain, less risk of complications, a shorter hospital stay and quicker recovery.

What is vaginal prolapse and who is at risk?

Vaginal prolapse is when the muscles at the top of your vagina become weak, causing your birth canal to fall from its normal position in your body and creating the sensation of a lump or bulge. People who have had a hysterectomy are at increased risk of vaginal prolapse.

How is vaginal prolapse diagnosed and treated?

Vaginal prolapse can be diagnosed during a routine pelvic exam by your Hoag gynecologist. Vaginal prolapse can be treated with:

• Pelvic floor exercises, such as Kegel exercises.
• Pelvic floor physical therapy.
• Vaginal pessary, a device that sits in your vagina, acting as a support structure.
• Vaginal vault suspension surgery, in which a surgeon will attach your vagina to the ligaments inside your pelvis that are used to hold it up
• Robotic-assisted sacrocolpopexy, which involves attaching a piece of mesh to your vagina and securing the mesh to your tailbone to give the vagina a lift.
• Colpocleisis, a surgical procedure that involves shortening the length of the vaginal canal. This procedure should only be considered if you do not want to have penetrative sex again.