Relief is Here: Prolapse Treatment at Shree IVF Clinic

What is Prolapse?

When the supportive tissues covering a part of the body weaken or stretch, occurs a bulge, dropping the organ down. This movement of the organ out of its original place is known as Prolapse. There are several types of prolapse, namely,

• Pelvic Prolapse
• Rectal Prolapse

Everything You Need to Know About Prolapse

Pelvic Organ| Why does | Stages | Symptoms | Causes | Diagnosis | Treatment | Types |  Surgery

Pelvic organ prolapse means when the organs forming a cover or floor to the pelvic area drop down. Most women are affected by this. The muscles surrounding the pelvic organs hold them in the right place,, but due to some problems, they might undergo flexing and stretching. Pelvic organs include the rectum, vagina, and uterus.

If there is a pelvic floor disorder,, then one or more of these organs might stop working properly. There are certain effects of pelvic floor disorder, which include pelvic organ prolapse, urinary inconsistency, and anal problems.

When the pelvic organs come down into or outside the anus or vaginal canal, it is given the following names:

• Uterine prolapse
• Urethrocele
• Vaginal prolapse
• Cystocele
• Enterocele
• Rectocele

Dr. Jay Mehta and his team are well-known across India for doing a large number of reconstructive pelvic and urogynecology surgeries. They also treat many women who have already had surgery once for pelvic organ prolapse but need it done again.

Pelvic organ prolapse is extremely commonly seen in India. Though it is commonly associated with birth trauma, especially due to prolonged labor and normal vaginal delivery, this disease is also seen in women who are in the postmenopausal age group. In India malnutrition also significantly contributes to a higher risk of prolapse. 

Prolapse predominantly occurs due to a defect in the endopelvic fascia. The endopelvic fascia keeps all the pelvic organs bound to each other. It consists of collagen and other fibroblasts and is predominantly strengthened and acted upon by estrogen.

In cases of oestrogen deficiency which is predominantly seen in postmenopausal women, the endopelvic fascia undergoes defects, which results in the development of pelvic organ prolapse.

Predominantly a lady would complain of something coming down from the vagina or out from the vagina. This is typically associated with urinary tract infections or constipation or slightly altered bowel motility.

On rare occasions the entire pelvic organ can prolapse outside, which is also called procidentia. Sometimes this can also present with vaginal bleeding, especially if there is the presence of an ulcer in the region of the prolapse.

Let us first categorize the four stages of pelvic organ prolapse:

• Stage I – The uterus will be in the upper half of the vagina
• Stage II – It will also descend to the opening of the vagina
• Stage III – It pokes out of the vagina
• Stage IV – It will come out of the vagina completely

It is hard to notice any symptom in particular. The symptoms are not universal, i.e., they vary according to the organ affected. If you remain very careful, then you may notice the possible signs.

• Lower back pain
• Pain during sexual intercourse
• Constipation
• Feeling unnecessary pressure in the pelvic area
• Problems related to urination
• Problems like blood clotting or spotting during menstruation

Very early stages of stress urine incontinence especially where it is associated only with leakage of very small drops causing just wetness in the vagina, can be treated with the help of Kegel exercises.

This typically involves controlled supervision under a physiotherapist, which helps in specific strengthening and contraction of pelvic floor muscles, which, in fact, after 3 to 4 months of therapy, may help in better control of the urine leak in early stages in social circumstances.

For any form of advanced-stage disease where there is a severe leakage of urine even on the lightest of activities, performing any form of pelvic strengthening is definitely going to have no benefit as a curative therapy for stress urine incontinence.

Urinary incontinence can be temporarily caused by urinary tract infections, which are extremely common in India.

This requires infection-specific treatment. It normally takes 2 to 4 weeks for it to subside. This may require the patient to take a specific course of antibiotics after a urine culture.

Clinical examination of urine leak on a partly filled bladder or a full bladder is one of the best methods to diagnose this condition.

If it is also associated with mixed or urge incontinence, then one may choose to do a urodynamic study.

There are a few specified causes, like,

• Hysterectomy (removal of the uterus through surgery)
• Cancer in the pelvic organs that causes constant disturbance in the abdominal area.
• Obesity can be one of the major reasons your body encounters flexing and stretching or fat formation in the pelvic area.
• Long-term problems related to coughing can put excessive pressure on your lower abdomen, leading to loosening of the muscles.
• Weaker tissues connecting the organs
• Chronic constipation
• Giving birth at a young age because the body parts are not yet ready.

This is predominantly diagnosed on clinical examination. Examination involves a predictive score of something called POP-Q (Pelvic Organ Prolapse Quantification). This allows for accurate mapping of the degree of prolapse.

Simultaneous examination of the patient is also done with a partly filled bladder in order to rule out any form of incontinence.

Usually by the time the patient approach is the doctor, the prolapse is typically symptomatic. At this stage, predominantly the patient is going to present with either grade 3 or grade 2 of prolapse wear, and some form of surgical correction would be warranted in order to ensure that the patient stays free of the symptoms.

However, very early prolapse, if it is diagnosed on routine clinical examination, can be treated by strengthening of pelvic floor muscles.

Anterior compartment, apical compartment, and posterior compartment. These are the three main locations where one can focus for examination and classification of pelvic organ prolapse.

However, typically this is usually a global prolapse when done in a clinical setting. Anterior compartment descent is also called cystocele, and posterior compartment descent is also called rectocele. 

Anterior compartment, apical compartment, and posterior compartment. These are the three main locations where one can focus for examination and classification of pelvic organ prolapse.

However, typically this is usually a global prolapse when done in a clinical setting. Anterior compartment descent is also called cystocele, and posterior compartment descent is also called rectocele. 

Laparoscopic surgery is considered to be the gold standard for operating on prolapse, especially if the repair is to be done with the help of a mesh or if the repair is to be done for a recurrent prolapse.

Vaginal mesh has been banned in most of the countries due to complications arising out of mesh erosion.

Vaginal repair is indicated especially when sacrospinous fixation is to be performed. An expert laparoscopic surgical team can easily perform the sacral fixation as well with laparoscopic surgery.

Vaginal surgery is typically associated with a much higher rate of recurrence and has to be used very sparingly in the treatment of prolapse. The traditional vaginal surgery, which involves anterior colporrhaphy and posterior colpoperrineorrhaphy, is extremely nonanatomical and causes a severe reduction in the vaginal laxity as well as in the vaginal length.

Though these are commonly performed procedures in India, these types of vaginal surgeries are to be avoided should a patient desire good sexual function following the repair for prolapse. The sexual function of the vagina is extremely well maintained if the laparoscopic surgery is performed.

Multiple procedures can be performed through laparoscopic surgery, which predominantly involves global repair of the prolapse with the help of the mesh. Dr. Jay Mehta and his team have introduced certain pioneering techniques of global prolapse repair, due to which they have a huge number of patients who require the services from them.

Dr. Jay Mehta and his team are extremely popular across the country for performing a very high volume of reconstructive pelvic and Urogynecological procedures. Get a consultation call now: 1800-268-4000 

No, when placed correctly, mesh is an extremely good device in order to support the endopelvic fascia so that the chances of recurrence of prolapse are drastically reduced. Mesh-related complications are predominantly due to an incorrect surgical technique.

Laparoscopic surgery for prolapse repair requires an extremely good surgical technique where one has to dissect in between the two layers of the endopelvic fascia. And then anchor the mesh correctly in between that space.

The patients are required to follow up in the hospital once a year for the next 3 years. Long-term complications if the surgical technique is correct or virtually next to zero.

Patients are encouraged to get back to work, including weightlifting, working on the farm, and doing all household work, as well as going to the office, within 3 to 4 days of surgery.

There are many young women who are yet to get married or even get to become pregnant who experience pelvic organ prolapse. Hysterectomy, or uterus removal, has virtually got no role in the surgery for prolapse repair.

However, in postmenopausal women the option to remove the uterus simultaneously is always given to them. Removal or conservation of the uterus does not increase or decrease the complexity of the surgery or the postoperative outcome or the long-term outcome for the patient in any manner.

Young women who undergo prolapse repair surgery and pelvic reconstruction can easily plan for pregnancy within 3 months of the surgery. Most of these patients have an absolutely uneventful outcome during pregnancy and can have absolutely normal and healthy children.

In young women, having pelvic organ prolapse is one of the most important causes of having infertility as well. Infravaginal elongation of the cervix is commonly seen in young women