Vaginal & Uterine Prolapse

The vagina is a muscular, tube-shaped organ running from the cervix of the uterus (the womb) down to an external opening at the vulva.  The vagina is also a very elastic, distensible organ that forms the birth canal through which babies are delivered from the uterus.

A network of muscles and ligaments around the vagina help hold the vagina in its place as well as the other pelvic organs that surround the vagina. When those muscles and ligaments are weak or damaged, the pelvic organs can begin to fall out of place — or "prolapse" — into the vagina.

There are four types of prolapse, depending on the organs affected:

• Cystocele — the urinary bladder sagging into the vagina

• Rectocele — part of the rectum sagging into the vagina

• Uterine or vaginal vault prolapse — the uterus dropping down into the vagina, or if the patient has had a hysterectomy, the top of the vagina itself falls downward.

• Enterocele — part of the bowel behind the top of the vagina sagging into the vagina

All of these conditions can cause serious health conditions, ranging from backache and interference with sexual pleasure to incontinence, an inability to empty the bladder and/or an inability to have bowel movements.

While surgical repair remains the best long-term option for vaginal and uterine prolapse, non-surgical options also exist. The primary non-surgical treatment is to place a device called a pessary into the vagina to prevent the pelvic organs from prolapsing.  Special physical therapy to strengthen the pelvic muscles may help to reduce prolapse symptoms in some patients with milder forms of prolapse.  For patients who are able to tolerate surgery, surgical repair offers the most effective long-term treatment. The procedure varies based on the kind of prolapse, as described below.

Cystocele

Surgery for a prolapsed bladder can be done through the vagina or through the abdomen using minimally invasive robotic surgery. The procedure also typically addresses any prolapse of the top of the vagina or the urethra — the tube that carries urine out from the bladder. 

Rectocele

Surgery for prolapsed rectum is typically done through the vagina. The surgeon also corrects any widening (“looseness”) of the vagina, which commonly occurs with this condition and thereby potentially improves sexual functioning and sexual pleasure for the patient and her partner.

Uterine or Vaginal Vault Prolapse

Historically, a hysterectomy has been performed for uterine prolapse. However, A prolapsed uterus can, in some cases, be moved back into place through the vagina or through the abdomen via minimally invasive robotic or open surgery.

If you have a prolapsed uterus, your doctor will perform a careful assessment to assist you in deciding whether to have a hysterectomy or a uterine-sparing surgery. If you and your doctor decide hysterectomy is appropriate, the procedure may be done through the vagina, as minimally invasive robotic surgery or through open abdominal surgery.

Enterocele

Surgery for prolapsed bowel can be done through the vagina or through the abdomen using minimally invasive robotic surgery or open surgery.