Diagnosis & Treatment Options for Pelvic Organ Prolapse in Tyler, TX

Don’t let your condition get you down. Many women between the ages of 50 and 79 report having symptoms of pelvic organ prolapse. To determine the best course of treatment, it is recommended that you consult with a urologist who specializes in treating pelvic floor disorders. The treatment plan will depend on the type of prolapse and your plans for the future, including potential pregnancy. With the right support, you will be able to find a solution that works for you. At your initial visit with Dr. Williams, he will begin the process of discovering what your issue is and begin an evaluation and treatment plan.

What is Pelvic Organ Prolapse?

Pelvic organ prolapse (POP) occurs when the muscles or ligaments in your pelvic floor are stretched or become too weak to hold your organs in the correct position. When this happens, organs such as the bladder, rectum, and uterus can bulge (prolapse) into the vagina and sometimes past the vaginal opening. Imagine a hammock tied between two trees. Now imagine that same hammock after years of heavy use.

What Types Of Pelvic Organ Prolapse Are There?

*Cystocele: this is when your pelvic muscles have weakened and allowed your bladder to drop down into the vaginal canal causing a large bulge. Patients have described this as a pulling or tugging sensation. Many women say it’s like tying a string around a brick and then attaching the other end to their spine or tailbone…then just letting the brick go!!

*Rectocele: this is when your pelvic muscles have weakened and allowed your rectal vault to protrude into the bottom portion of your vaginal canal. Often times patients will complain of a bulge but also difficulty in having bowel movements.

*Enterocele: this is when a lady has had a prior hysterectomy and there are no longer any attachments outside the vagina to keep it supported and the back end so in the absence of a uterus, the intestines fall into the lower pelvis and cause the end of the vaginal canal to push inwards.

How is Pelvic Organ Prolapse Diagnosed?

Prolapse is a very common problem affecting millions of women.2 However, many women believe that their condition is a normal part of aging. Remember, “common” does not mean “normal.” Others are unaware of this condition and its treatment options. With the treatment options available today, women no longer have to live with this uncomfortable condition.

After discussing your medical history and symptoms with Dr. Williams, he will confirm a diagnosis using a cystoscope to inspect the inside of your bladder and perform a simple vaginal exam using a speculum. He may need to schedule additional tests such as in-office videourodynamics to assess the function of the bladder and see whether there are other issues that he cannot detect with a simple physical examination. These evaluations help him determine the best treatment options for you.

What are the Treatment Options for Pelvic Organ Prolapse?

Dr. Williams prefers to use a cadaveric harvested dermal graft for both cystoceles and rectoceles and has had great success!!! Both repairs require a suture to tack the back side of the graft to the sacrospinous ligaments that run from the lower pelvic bones to the sacrum. Many women have told Dr. Williams that they feel like they have 20-year-old vaginas again!!!

It is important to understand your body and learn about all your treatment options, both non-surgical and surgical, to help find a solution that is right for you. Finding a urologist who specializes in pelvic floor treatments and can discuss your options to find the best solution for you is imperative.

Non-surgical Management Options
Prolapse may be managed with vaginal pessaries, Kegel exercises, biofeedback, and lifestyle changes. These options may involve long-term treatment, ongoing maintenance, and continued expenses, and they may not address your underlying condition.

Vaginal Pessary is a device that’s placed in the vagina to support the pelvic floor and support the prolapsed organ. The pessary must be cleaned frequently and may have to be removed before intercourse and is typically placed and managed by a gynecologist. Dr. Williams if a firm believer that the vast majority of patients do not like this option long-term because of discomfort, lack of effectiveness, poor satisfaction.

Kegels are exercises that you can do on your own to help strengthen your pelvic floor muscles.

Biofeedback Therapy/Uroplasty (tibial nerve stimulation) involves learning how to essentially be more cognizant of your body and pelvic floor. By using a monitoring device, you will be asked to use your levator ani muscles (puborectalis, pubococcygeus, and iliococcygeus muscles) to see how much strength you need to contract your pelvic floor muscles correctly, or in some cases, how to properly relax them. Nerve stimulation typically is once a week for 8 weeks whereby non-painful, light electrical impulses are utilized to reset or reprogram the nerves controlling the bladder and may, in some cases, increase the pelvic floor muscles. But the therapy alone will not reduce any vaginal prolapse.

Surgical Options for Pelvic Organ Prolapse

Surgical repair can be done through the vagina or through the abdomen.

• Anterior or posterior colporrhaphy in which the wall of the vagina is strengthened with sutures so that it once again supports the pelvic organs. However, these repairs do not last usually longer than just a few short years.
• Vaginally placed biologic tissue (“transvaginal”) is done through an incision in the vagina.
• Sacrocolpopexy and sacrohysteropexy are done through the abdomen to repair vaginal vault prolapse and uterine prolapse with surgical mesh.

Reconstructive surgery of the pelvic floor is performed with the goal of restoring the organs to their original position.

*Transvaginal sacrospinous fixation with sacrocolpopexy using dermal graft. This has been performed in the past using mesh. Although the vast majority of these cases went well (especially in my hands) both nation and world-wide, there were high enough complications reported that using mesh for vault prolapse using a transvaginal approach (not abdominal approach) was removed as a surgical option.

Because the vast majority of women do not like the idea of a large sheet of mesh placed in their abdomen near their intestines and do not want scars on their abdomen, a transvaginal approach was and still is, the preferred method.
However, with transvaginal mesh no longer allowed, a few companies developed products such as myocardium and dermal grafts that had very little if any risk of mesh complications such as “exposure” or “erosion.”

Additional exams that might be necessary to assess the symptoms or severity and types of incontinence include:

• A pelvic MRI provides images of the pelvic area to allow closer examination of your pelvic organs and structures (rarely needed).
• Urodynamic study or testing focuses on how the bladder, sphincters and urethra work together to store and release urine; it also assess pelvic floor dysfunction/overactivity which is often missed and cannot be identified with a simple physical exam alone.
• Cystoscopy involves a cystoscope (small flexible or rigid camera) to visually examine your bladder and urethra.