Your treatment will depend on the type of pelvic organ prolapse you have. Your doctor may recommend first treating your prolapse without surgery. In some people, if symptoms significantly affect quality of life, surgery is eventually necessary.
Menopause results in lower estrogen levels, which weakens the muscles of the vagina. Estrogen therapy may strengthen these muscles. However, some people shouldn't use estrogen, so discuss risks and benefits with your doctor. If you develop symptoms of one type of prolapse, you're more likely to develop other types. Mayo Clinic doctors try to correct all prolapse-related problems at one time.
Physical therapy may include pelvic floor exercises using biofeedback to strengthen specific muscles of the pelvic floor. Biofeedback involves the use of monitoring devices with sensors that are placed in your vagina, rectum or on your skin. As you perform an exercise, a computer screen shows whether you're using the right muscles and the strength of each squeeze (contraction) so you learn how to do the exercises properly.
Mayo Clinic doctors may use minimally invasive (laparoscopic) surgery, including robot-assisted surgery, to treat some types of pelvic organ prolapse. Minimally invasive surgery allows your surgeon to make smaller incisions and can shorten your hospital stay. Talk to your surgeon about why one procedure may be better for you than another, what the surgical approach will be, and what materials will be used. Also ask your surgeon about the long-term success for your planned procedure.
There are different surgical strategies for various types of prolapse:
- Posterior prolapse. A posterior prolapse often involves the rectum and is sometimes called a rectocele. Your surgeon secures the connective tissue between your vagina and rectum to help keep the rectum in its proper position. Your surgeon also removes excess tissue.
- Anterior prolapse. An anterior prolapse often involves the bladder and is sometimes called a cystocele. Your surgeon pushes your bladder up and secures the connective tissue between your bladder and vagina to keep the bladder in its proper position. The surgeon also removes excess tissue. If you have urinary incontinence, your doctor may use a bladder neck suspension or sling to support your urethra.
- Uterine prolapse. If you don't plan to have more children, your surgeon may recommend surgery to remove the uterus (hysterectomy) to correct uterine prolapse.
Small bowel prolapse and vaginal vault prolapse. Small bowel prolapse is also sometimes called enterocele. In women who have had a hysterectomy, this type of prolapse is also called vaginal vault prolapse and may involve the bladder, rectum or small bowel. Your surgeon may perform corrective surgery through the vagina or abdomen.
In a vaginal approach, your surgeon will use the ligaments that support the uterus to correct the problem. In an abdominal approach — which may be performed laparoscopically, robotically or as an open procedure — your surgeon attaches the vagina to the tailbone at the base of the spine, and small portions of synthetic mesh may be used to help support vaginal tissues. This type of surgery is called vaginal vault suspension.
Prolapse surgery repairs the tissue bulge. If the bulge doesn't bother you, surgery isn't needed.
Read more about treatment for anterior prolapse (cystocele), posterior prolapse (rectocele), uterine prolapse, and small bowel prolapse (enterocele).
Nov. 20, 2012