Pelvic Floor Reconstruction

Pelvic Floor Reconstruction Surgeons

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 in Plano has pain and discomfort from pelvic organ prolapse that does not respond to nonsurgical treatment and lifestyle changes, the Women’s Specialists of Plano may recommend a pelvic floor reconstruction.

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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.

Types of Pelvic Floor Reconstruction Surgery

At Women’s Specialists of Plano, we offer several different types of pelvic floor reconstruction including:

Apical Suspension

Pelvic organ prolapse (POP) affects millions of women in the United States. When the uterus, cervix or vaginal vault loses its normal attachment or elasticity inside the body and descends, it is called an apical prolapse. This can occur from the aging process, childbirth or hysterectomy. An apical suspension is a type of pelvic floor reconstruction that restores the support of the top of the vagina or the vaginal vault or apex. There are different types of apical suspension, one of these specialized treatments is called a Uterosacral Ligament Fixation.

Uterosacral Ligament Fixation

Uterosacral Ligament suspension is a surgical treatment used to restore support to the uterus (womb) or to the vaginal vault (the top of the vagina if a woman has had a hysterectomy).  The strong, supportive ligaments that attach the cervix to the sacrum (neck of the womb to the bottom of the spine) are called the uterosacral ligaments. If these ligaments become weak and stretch, it can contribute to pelvic organ prolapse.

In the video below, Dr. Elizabeth Coronado performs a uterosacral ligament suspension and describes how this surgery involves stitching the uterosacral ligaments to the apex (top) of the vagina and restoring normal support to the top of the vagina. Dr. Coronado can perform this specialized procedure at the same time as a hysterectomy to avoid future prolapse, or it can be combined with other pelvic floor reconstruction techniques for prolapse or incontinence.

Anterior Vaginal Prolapse Repair

An anterior vaginal prolapse occurs when the bladder or urethra slips out of place and down, into the vagina. An anterior vaginal prolapse repair is the name of the surgical procedure used to correct an anterior vaginal prolapse. This specialized procedure repairs the vaginal wall and tightens the front wall of the vagina. The tightening of these muscles and soft tissues, helps pull the bladder and urethra into its proper position and keeps it from prolapsing (moving out of place.)

Posterior Vaginal Prolapse Repair

Posterior Vaginal Prolapse is also called Rectocele and occurs when the tissues between the rectum and the vagina weaken, causing the rectum to bulge into the vagina. Posterior vaginal prolapse can cause vaginal or rectal pressure, difficulty having a bowel movement and discomfort during sexual intercourse.

There are three types of surgery used to repair rectocele or posterior vaginal prolapse. These surgical procedures can be done individually, or in conjunction with other prolapse repairs and include:

Posterior Colporrhaphy

A minimally invasive technique used to correct pelvic organs that have dropped out of their normal position. A posterior repair is used to tighten the back (posterior) wall of the vagina.

During this procedure, an incision is made in the posterior wall of the vagina in order to identify the weakened area. Sutures are placed in the weakened area which strengthen the fibromuscular layer of the vagina which separates the rectum from the vagina.

Perineorrhaphy

A minimally invasive technique used to reconstruct the perineal body. Often done at the same time as a posterior colporrhaphy, a perineorrhaphy further helps to support the posterior vaginal wall.

During this procedure, excess vaginal skin can be removed and the minimally invasive incision is closed using absorbable sutures.

Obliterative Procedures

Different from reconstructive surgeries to correct a prolapsed vagina, restoring normal anatomy, an obliterative surgery corrects a prolapse by removing (or closing off) all or part of the vaginal canal. The purpose of obliterative procedures is to prevent further prolapse.

This procedure, reserved for women who are no longer sexually active, detaches the vaginal skin from the underlying connective tissue and brings the top wall of the vagina to the bottom wall, shortening the vagina. Bodily function remains the same, patients are able to pass urine and have bowel movements and the vagina continues to appear normal from the outside.

There are two types of obliterative procedures:

Partial

Also called colpocleisis. Designed to treat urinary incontinence and prolapse in older women who are not sexually active. Involves a partial closer of the vagina.

Complete

Also called colpectomy. It involves the surgical removal of all of the vagina. It is a minimally invasive and a very successful way to treat pelvic organ prolapse in women that are no longer sexually active.

Pelvic floor reconstruction surgery offers variable approaches and depends on a woman’s age, overall health, symptoms and diagnosis. To learn more about pelvic organ prolapse symptoms and treatments, please contact the Plano, Frisco and Dallas, Texas area office of Women’s Specialists of Plano today.

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