Pelvic Organ or Uterine Prolapse
Any number of circumstances—child birth, weight gain, even strenuous physical activity - can cause a weakening in the muscles and connective tissues within the pelvic floor cavity. That's problematic because these muscles and tissues hold the pelvic organs—vagina, uterus, bladder and rectum—in place, defending against the force of gravity.
In extreme cases of vaginal prolapse, internal tissue may be exposed externally.
"Prolapse is basically a weakening of the muscle or tissue, it's like a hernia, and it can cause pelvic organs to change their anatomical conditions from inside to outward," said Dr. Obianwu. "There are different types of prolapses - the uterus and vaginal vault can prolapse, the rectum or bladder can prolapse, moving downward toward the vagina. Once we do the examination, we can tailor the treatment depending on what pelvic organ is herniating."
While prolapse can happen in younger women, it tends to occur mostly in women after child bearing, he said. "I would say in my practice one out of six women in that age group has some sort of prolapse and I see quite a few pelvic organ prolapses."
In mild cases of prolapse, non-surgical techniques are good options. They include Kegel exercises to strengthen the pelvic floor muscles or pessaries, plastic devices inserted via the vagina to hold organs in place.
The surgical approach to prolapse has improved as surgeons realized that the condition is akin to hernias that general surgeons repair. In the past, surgical procedures to secure organs in place too often "tried to attach bad tissue to other bad tissue," said the surgeon.
"We now understand that we have to remove bad tissue and attach organs to healthy tissue or use a synthetic material to support organs," said Dr. Obianwu. "You don't always have to remove the prolapsed uterus, for example. It can be supported with a mesh and re-attached back to the original support ligaments. This can be done laparoscopically and we can achieve even better results with robotic assistance, in some selected cases."
