Pelvic Floor Reconstruction

An Overview of Pelvic Floor Reconstruction

Pelvic organ prolapse, also referred to as pelvic floor dysfunction, is a common condition and can vary among women living in the Plano, Frisco and Dallas, Texas area. About 35% of women will develop some form of pelvic organ prolapse in their lives, but not all will report moderate to severe symptoms that require a surgical treatment. If a woman has pain and discomfort from pelvic organ prolapse that does not respond to nonsurgical treatment and lifestyle changes, a physician at Women’s Specialists of Plano may recommend a pelvic floor reconstruction.

The pelvic floor consists of the muscles, ligaments, connective tissue and nerves that support and control the rectum, uterus, vagina, and bladder. Pelvic organ prolapse is most often linked to strain during childbirth. Normally, your pelvic organs are kept in place by the muscles and tissues in your lower belly. During childbirth, these muscles can get weak or stretched. If they don’t recover, they can’t support your pelvic organs. You may also get pelvic organ prolapse if you have surgery to remove your uterus (hysterectomy). Removing the uterus can sometimes leave other organs in the pelvis with less support. Certain activities such repeated heavy lifting, chronic disease, or surgery are also causes.

Symptoms of Pelvic Organ Prolapse

Symptoms will vary and range among women depending on the actual diagnosis. However, in almost all cases, symptoms are often made worse with physical activities such as prolonged standing, jogging, coughing, jumping, or bicycling.  Symptoms of pelvic organ prolapse include:

• Feeling as if something is falling out of your vagina.
• Bladder problems; urinary incontinence.
• Feeling pressure from pelvic organs pressing against the vaginal wall. This is the most common symptom.
• Feeling very full in your lower belly.
• Feeling a pull or stretch in your groin area or pain in your lower back.
• Having problems with your bowels, such as constipation.
• Having pain in your vagina during sex.

Types of Pelvic Prolapse

Vaginal vault prolapse- Vaginal vault prolapse occurs when the upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal or outside of the vagina. It may occur alone or along with prolapse of the bladder (cystocele), urethra (urethrocele), rectum (rectocele), or small bowel (enterocele). Vaginal vault prolapse is usually caused by weakness of the pelvic and vaginal tissues and muscles. It happens most in women who have had their uterus removed (hysterectomy).

Cystocele, the bulging bladder- A cystocele occurs when the wall between a woman’s bladder and her vagina weakens and allows the bladder to droop into the vagina. A cystocele forms when the normally flat upper vaginal wall loses its support and sinks downward. This condition may cause discomfort and problems with emptying the bladder. When a cystocele becomes advanced, the bulge may become visible outside the vaginal opening. A bladder that has dropped from its normal position may cause two kinds of problems—unwanted urine leakage and incomplete emptying of the bladder. In some women, a fallen bladder stretches the opening into the urethra, causing urine leakage when the woman coughs, sneezes, laughs, or moves in any way that puts pressure on the bladder.

Enterocele, the female hernia- An enterocele occurs when your small intestine (small bowel) drops into the lower pelvic cavity and protrudes into your vagina, creating a bulge. An enterocele is a vaginal hernia. To repair the enterocele, the supportive structure must be reconstructed. Among all types of female prolapse, enteroceles share the most similarities with hernias that can develop in the abdominal and groin areas of both women and men: both involve bulging of the intestines into weakened supports nearby. In a man, hernias bulge through the abdominal wall; in a woman, enteroceles bulge into the top of the vagina. The symptoms are often vague, including a bearing down pressure in the pelvis and vagina, and perhaps a lower backache. They often exist alongside vaginal vault prolapse in women who have had a hysterectomy.

Rectocele, the bulging rectum­- A rectocele occurs when the tissues and muscles that hold the end of the large intestine (rectum) in place are stretched or weakened. This can allow the rectum to move from its natural position and press against the back wall of the vagina. Sometimes the tissues separating the two are so weak that the rectum bulges into the back wall of the vagina.

This creates an extra pouch in the normally straight rectal tube. Rectoceles often cause symptoms in their early stages and the symptoms are related to incomplete emptying of the rectum. Even a rectocele bulge that cannot be visualized at the vaginal opening may cause difficulty with bowel movements – including the need to strain more forcefully, a feeling of rectal fullness even after a bowel movement, increased fecal soiling, and in some cases incontinence of stool or gas. Those symptoms result from stool and air remaining within the rectocele pouch even after defecation, in contrast to the normal rectum, which fully empties.

Physicians will often time try to treat pelvic floor prolapse by a variety of nonsurgical therapies first, but many females have found successful treatment with Pelvic Floor Reconstructive Surgery. This surgery consists of several procedures for correcting pelvic organ prolapse and the goal is to restore the normal structure and function of the female pelvic organs.

Treatments for Pelvic Organ Prolapse

Conservative:

Depending on the exact nature of your prolapse and its severity, you and your physician may discuss changes to your diet and fitness routine. If your symptoms are mild, you may be able to do things at home to help yourself feel better. You can relieve many of your symptoms by incorporating daily exercises such as Kegels that make your pelvic muscles stronger. Reach and stay at a healthy weight. Cut back on caffeine, which acts as a diuretic and can cause you to urinate more often. Avoid lifting heavy things that put stress on your pelvic muscles.

Pessary:

For symptoms that are persistent and more severe, a pessary may be considered.  This is a rubber or plastic device, inserted vaginally and designed to relieve symptoms when in place. If you still have symptoms, your doctor may have you fitted with a device called a pessary to help with the pain and pressure of pelvic organ prolapse. It is a removable device that you put in your vagina. It holds the pelvic organs in place. But if you have a severe prolapse, you may have trouble keeping a pessary in place.

Surgery:

Surgery is another treatment option for serious symptoms of pelvic organ prolapse. But you may want to delay having surgery if you plan to have children. The strain of childbirth could cause your prolapse to come back. In recent years, dramatic advances have been made in the surgical treatment of this common gynecological condition.

If you have pain and discomfort from pelvic organ prolapse that does not respond to nonsurgical treatment and lifestyle changes, you may want to consider surgery, such as pelvic floor reconstruction. The choice of surgery depends upon which organs are involved, how bad your symptoms are, and what other medical conditions are present. In addition, your surgeon may have experience with and preference for a certain procedure. The goals of surgery are to relieve your symptoms and restore the normal functioning of your pelvic organs.