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Any number of circumstances-child birth, weight gain, aging, even strenuous physical activity-can contribute to a weakening in the muscles and connective tissues within the pelvic cavity. This lapse in structure and organ position is most evident at the base or floor of the pelvis, due to the inevitable, life-long pull of gravity. Problems can follow because the muscles and tissues here hold the pelvic organs-vagina, uterus, bladder and rectum-in place. Prolapse, or protrusion of organs and tissue from their normal position, can result from this weakening.

Weakening of the pelvic floor is common and, today, treatable.

Prolapse is similar to a hernia, in that organs or tissue can visibly or painfully bulge from their correct position. The uterus and vaginal vault can prolapse, or the rectum or bladder can prolapse, moving downward toward the vagina. In extreme cases of vaginal prolapse, internal tissue may be exposed externally. (Or, rarely, herniated areas can become squeezed or strangulated, causing inflammation, infection or rupture that is dangerous.) Among other conditions, this weakness and stress can contribute to stress urinary incontinence. It can sometimes cause vaginal ulceration or difficult with sexual function or bowel movements. Prolapse occurs more often in women who have had multiple children, large babies or who engage in strenuous physical labor.

© 2011 Intuitive Surgical, Inc.

Managing According to Individual Condition

While prolapse can happen in younger women, it tends to occur mostly in women who have had children, are somewhat older or both. In fact, a significant percentage of women have prolapse after the child-bearing period. In many cases, the prolapse is mild and causes negligible or manageable symptoms; in other cases, it requires treatment.

The Virtua team tailors the course of care to the specific weakening or malpositioning discovered. In modest 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). More serious cases require intervention through surgery.

Improved Methods of Restoring Pelvic-Floor Stability

As understanding of prolapse has improved, so has the dependability of surgical procedures and devices to treat it. The Virtua gynecologic surgery team has a depth of experience in repairing prolapse, customizing the operation for the needs of each patient. The team resects bad tissue and reattaches organs to stable, healthy tissue. The surgeon may use synthetic material, often in the form of a mesh sling implanted internally, to support organs.

That means that the surgical team can often avoid having to remove prolapsed organs. The surgeon, for example, can surgically tighten musculature, can support the uterus and can re-attach prolapsed organs to original support ligaments. The team can perform this procedure laparoscopically and, in select cases, uses the robotic surgical system to deliver the procedure.

Sacrocolpopexy is a procedure to surgically correct vaginal and uterine prolapse through use of to hold the vagina in the correct anatomical position. Tens of thousands of patient undergo this procedure each year in U.S. It can also be performed following a hysterectomy to treat uterine prolapse to provide long-term support of the vagina.

Sacrocolpopexy has traditionally been performed as an open surgery, requiring a 6-12 inch incision in the lower abdomen in order to manually access the inter-abdominal organs, including the uterus. But robotic surgery requires only small puncture incisions that cause little disruption of the abdominal muscles and minimal scarring.

If reconstruction of the pelvic floor is not possible or effective or desired, some patients may elect to undergo hysterectomy to resolve prolapse.

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