Pelvic Organ Prolapse

Pelvic organ prolapse is a condition that can be caused by childbirth or traumatic injury. In extreme cases, damage to the lower abdomen might require vaginal reconstruction.
Although the term vaginal prolapse is often used generally, any pelvic organ - such as the uterus, bladder, or top of the vagina - can prolapse. This means that it begins to drop or sink because the muscles and connective tissue of the abdomen can no longer support it. Many women who have given birth have prolapse in one or more of their pelvic organs (there is a higher risk for prolapse with vaginal birth than with cesarean birth). It can also be caused through injury, such as in an automobile or bicycle accident.
If you have minor pelvic organ prolapse, you may not notice any symptoms or not be bothered by it. But in a more severe case, you may notice some of the following symptoms:
  • bulge in the vagina, which can be made by other organs
  • pain or heaviness in the abdomen, pelvis or lower back, that may get worse with standing or lifting
  • urinary incontinence or unexplained constipation
  • difficulty inserting tampons
  • problems or pain with sex  
In the most severe cases, pelvic organs may actually stick out of the vagina at times and need to be pushed back in.
Many cases do not need to be treated, but if your symptoms are affecting your quality of life, you and your doctor may decide to treat the problem. Treatment options include:
  • diet or lifestyle changes
  • pelvic floor exercises that strengthen the muscles holding your organs in place
  • devices, such as a pessary, which are inserted into the vagina and help support your pelvic organs
  • surgery, performed either through an opening in the abdomen, or vaginally  
Occasionally, some women have childbirth trauma or pelvic organ prolapse that is extensive enough that surgery is needed to reconstruct your vagina. Damage might also be caused by:
  • high impact to the vagina and/or vulva, such as from falling on the crossbar of a bicycle
  • injury from rape
  • injury from a weapon that penetrates the vaginal area, such as a knife
  • treatment of vaginal cancer  
There are also other types of vaginal reconstruction that are done for cosmetic reasons or comfort, or to improve your sexual function. For example:
  • labiaplasty, in which enlarged tissue of the labia minor is reduced
  • vaginoplasty, which restores elasticity by tightening the vagina and surrounding muscles
  • hymenoplasty, in which the hymen is reconstructed (to restore virginity)  
Usually the pain and damage from an event such as one of those above will be acute enough that you will be seeing a doctor right away. The doctor will examine the damage thoroughly, and may want to perform surgery to fix the problem as soon as possible. If your need results from a longer term condition, your doctor will discuss it with you.
If your vagina needs more than just repair, because some or all of it needs to be removed (for example, due to cancer treatment), a surgeon will usually use tissues and muscles from other parts of your body, such as the bowel, thigh, or lower abdomen, to reconstruct your vagina.
The procedure usually takes from 1-2 hours, and may involve either a local or general anesthetic, depending on how extensive the surgery is.
You will have swelling and discomfort for 5-6 days. You may feel completely recovered within ten days to two weeks, but usually you should abstain from sexual intercourse for at least six weeks. Talk to your doctor about when you can resume your previous activity level.
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