Prolapse of Pelvic Organs

There are several different types of vaginal prolapses: When the uterus falls down, it is called Uterine Prolapse. The uterus is the muscular organ at the top of the vagina. In uterine prolapse, your uterus moves from its normal position down into your vagina. The uterus may be only slightly out of position, or it may descend so far that it can be seen outside the vagina. The severity of uterine prolapse is classified by degree:

• In first-degree uterine prolapse, the cervix is visible when the perineum is depressed.
• In second-degree prolapse, the cervix is visible outside of the vaginal introitus, while the uterine fundus remains inside.
• In third-degree prolapse, or procidentia, the entire uterus is outside of the vaginal introitus.

Uterine prolapse is associated with incontinence, vaginitis, systitis, pelvic pressure and pelvic pain. If the anterior vaginal wall and bladder fall down, it is called a Cystocele. A cystocele occurs when the tissues between the bladder and the vagina weaken, leading to a herniation of the bladder.

If the posterior vaginal wall and rectum fall down it is called a Rectocele. The patient may report having to manually reduce the Rectocele before defecation.

Sometimes, a space develops between the vagina and rectum into which small bowel, usually the sigmoid colon, can bulge. This is referred to as an Enterocele.

Sometime after hysterectomies, the vaginal vault may prolapse as well. Such Vault Prolapse may or may not cause symptoms. The position of the vagina relative to the rest of the body is somewhat like the finger of a surgical glove, which is tucked inside the rest of the glove. In this way, an enclosed area surrounds the vagina. If the pressure in that area is increased as, the vagina tends to be pushed downward and to protrude outward creating a vault prolapse.

Although surgical repair of certain pelvic support defects offers most of the time a permanent solution, some patients may elect to use a pessary as a temporary solution. The pessary is most commonly used in the nonsurgical management of pelvic support defects. Multiple vaginal deliveries can weaken the musculature of the pelvic floor. Hysterectomy or other pelvic surgery can predispose a woman to weakness of the pelvic floor, as can conditions that involve repetitive bearing down, such as chronic constipation, chronic coughing or repetitive heavy lifting. As the geriatric population continues to increase, more patients are presenting with pelvic floor defects. While many of these patients are poor candidates for surgery, most of them can safely use a pessary.

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