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Obstetrics Gynecology Conditions & Treatments - row of books

Pelvic Organ Prolapse

What is pelvic organ prolapse?

Pelvic organ prolapse is a condition in which one or more pelvic organs descend in the pelvis and sometime protrude from the vaginal opening. It’s a common condition, affecting about one of every three women age 45 or older. In its milder stages, there are no symptoms and no treatment is needed.

Pelvic organ prolapse can be caused or aggravated by smoking, menopause, obesity, family history, coughing, chronic constipation, pelvic trauma or previous surgery, repeated heavy lifting, multiple vaginal deliveries, loss of muscle tone, estrogen loss, and certain medical conditions such as diabetes or connective tissue disorders.

What are the symptoms of pelvic organ prolapse?

Pelvic organ prolapse symptoms include:

  • disturbances in normal bladder or rectal function
  • feelings of pelvic pressure, heaviness, bulging or pain
  • recurring bladder infections
  • excessive vaginal discharge
  • discomfort or lack of sensation during sexual intercourse

How is pelvic organ prolapse treated?

Pelvic organ prolapse symptoms can sometimes be improved with pelvic floor physical therapy or Kegel exercises.  Another non-surgical option is the use of a pessary (an elastic or rigid device that is inserted into the vagina to support the uterus).

For women whose medical conditions or personal circumstances call for definitive treatment, Dr. Garofalo offers treatment of pelvic organ prolapse by using a surgical procedure known as sacrocolpopexy. If this type of procedure is not suitable, Dr. Garofalo can also perform site-specific pelvic reconstructive surgery.

Sacrocolpopexy

Sacrocolpopexy, the gold standard for treatment of pelvic organ prolapse, is a procedure which uses synthetic mesh to support the muscles and connective tissue which span the area underneath the pelvis. This minimally invasive surgery takes only one to two hours and can be performed using general or regional (epidural or spinal) anesthesia. Sacrocolpopexy can be performed following a hysterectomy to provide long-term support of the vagina.

Unlike vaginal suspension procedures, which are performed by vaginal access, sacrocolpopexy is performed by abdominal or laparoscopic access. Another difference is that vaginal suspension procedures suspend the synthetic mesh from pelvic ligaments, while sacrocolpopexy suspends the mesh from the sacrum – a large, triangular bone at the base of the spine. These differences result in a more accurate repair when using sacrocolpopexy, with lower failure rates and fewer associated complications.

While sacrocolpopexy can be performed as open surgery or with a laparoscope, Dr. Garofalo recommends da Vinci assisted laparoscopic sacrocolpopexy.  A assisted laparoscopic sacrocolpopexy uses state-of-the-art surgical  computer technology that  to convert Dr. Garofalo’s hand movements into precise micro-movements of the da Vinci laparoscopic instruments.

Compared to open surgery, women who undergo this procedure typically experience less pain, bleeding, and scarring, and fewer complications with a shorter hospital stay and faster recovery.

Pelvic reconstructive surgery can be performed through the vagina, or with an abdominal incision, or through laparoscopic access. During pelvic reconstructive surgery, the prolapsed organ or organs are repositioned and secured to the surrounding tissues and ligaments, and vaginal defects are repaired.

What risks are associated with sacrocolpopexy?

Although complications associated with sacrocolpopexy are unlikely, they can include difficulty urinating and possible injury to blood vessels, nerves, bladder and bowel. There is also a small risk of the mesh material becoming exposed in the vaginal canal. These conditions can be repaired with surgery. Temporary leg pain may also occur.

Synthetic mesh procedures are not appropriate for pregnant women or for women planning future pregnancies.

What is the recovery period following sacrocolpopexy?

Patients usually return home the day after sacrocolpopexy. Many patients resume most normal daily activities within four days and will have fully recovered in two weeks. Heavy lifting, strenuous exercise and sexual intercourse should be avoided for up to six weeks.