What is Pelvic Relaxation Surgery (pelvic organ prolapse)?
Pelvic organ prolapse (also known as Pelvic relaxation) is a condition in which the supporting structures of the pelvic floor become weakened, causing one of the pelvic organs to drop downward and press against the vagina, creating a bulge or protrusion.
The organs of the pelvis—the area between your hip bones—include the vagina, uterus, cervix, bladder, urethra (the tube through which urine passes), intestine, and rectum. These organs are held in place by muscles, ligaments, and other supporting tissue.
When this support system becomes stretched, weakened, or torn, the pelvic organs can slip out of place and drift downward, pressing against the vagina.
What are the symptoms of pelvic organ prolapse?
The general symptoms associated with pelvic relaxation depend on which organs are affected.
Sometimes only the uterus comes down, but other times the bladder and the top of the vagina come with it. This can cause feelings of fullness in the pelvis, discomfort that can affect sexual function, and sometimes even a noticeable bulge of tissue at the opening of the vagina.
When the supports for the bladder and bladder stem (urethra) are weakened due to childbirth, the bladder often leaks urine when a person is coughing, laughing, or running (known as stress urinary incontinence). Some women may leak urine during or after sexual intercourse, a problem they are often too embarrassed to share with anyone, including their doctor.
Sadly, this impacts the quality of life for too many women who suffer in silence.
Is there more than one kind of pelvic organ prolapse?
Yes! There are several different kinds of prolapse, depending on the organ involved, such as:
- Uterine prolapse
The most common type of prolapse involves the uterus and cervix dropping down into the vaginal canal and sometimes even protruding past the vaginal opening.
- Vaginal vault prolapse
Vaginal vault prolapse is when the top of the vagina (known as the “vaginal vault”) drops into the vaginal canal. This is seen in women who’ve had a hysterectomy (removal of the uterus).
Cystocele is when the bladder bulges into the vagina.
Rectocele is when the end of the large intestine (rectum) pushes against and moves the back wall of the vagina.
Enterocele is when the small intestine bulges against the vaginal wall. This can sometimes accompany uterine prolapse.
What causes pelvic organ prolapse?
The most common causes of pelvic organ prolapse include:
The risk of prolapse is greater after vaginal delivery than after a C-section.
Surgeries such as a hysterectomy are a common cause of organ prolapse.
As we age, all of our muscles and ligaments weaken.
- Repeated increased abdominal pressure
This pressure comes from being overweight, frequently straining during a bowel movement, or repeated coughing.
- Genetic factors
One person’s pelvic support system may be naturally weaker than another because of hereditary.
- Extreme physical activity or lifting of heavy objects
Increased pelvic pressure from extreme activity or lifting can cause one or more pelvic organs to drop or press into or out of the vagina
How is pelvic organ prolapse treated?
Non-surgical treatments of pelvic organ prolapse include:
- Exercise techniques like yoga and stretching, designed to relax your pelvic floor muscles can help. Unfortunately, Kegel exercises, or similar techniques that require you to contract your muscles, do not help this condition.
- Dietary changes such as increasing fiber intake can decrease constipation and straining.
- Warm baths can relax your pelvic muscles while improving circulation to the area.
- Avoiding straining while going to the bathroom will help reduce stress on your pelvic muscles.
- Muscle relaxants might be prescribed to prevent your pelvic muscles from contracting.
- Biofeedback is often successful. Using special sensors, a therapist monitors how you relax or contract your pelvic muscles and teaches you how to improve your coordination.
- When non-surgical treatments fail to improve symptoms, there are surgical procedures for vaginal repair to return the pelvic organs to their normal position.
Watch Dr. Aliabadi remove an 8-pound fibroid tumor laparoscopically on The Doctors TV Show.
Pelvic organ prolapse surgery
There are actually three types of pelvic organ prolapse surgeries, which are:
- Open abdominal approach
This is done by making a large midline incision in your lower abdomen to access and repair your prolapsed organ. In this traditional approach, a 7-inch incision (at least) is made in the lower abdomen along the bikini line.
- Transvaginal approach
This is done by performing the prolapse repair through the vagina
- Minimally invasive approach
This is known as a Laparoscopy and involves just two or three 5mm incisions that, after six months of healing, usually are undetectable.
What does a laparoscopic approach to correcting pelvic organ prolapse involve?
In a laparoscopy, the surgeon inserts very small, specialized instruments through tiny abdominal incisions to examine and operate on your pelvic organs. During surgery, your doctor may use your own body tissue or synthetic mesh to suspend the fallen organ at the correct height or to build pelvic floor support.
The two laparoscopic procedures for pelvic organ prolapse are:
This procedure repairs the collapse of the dome of the vagina (the vaginal vault) which causes it to drop into the vaginal canal. This condition can sometimes occur after a hysterectomy.
In a sacrocolpopexy procedure, the surgeon attaches surgical mesh to the vagina and fastens it to a strong ligament in the front of the sacrum (the “tail bone” at the base of the spine). The mesh is used to pull the vaginal dome up into its normal position.
If a patient still has her uterus and does not plan future pregnancies, it can be removed during this procedure, with or without leaving the cervix in place. If the patient has urinary stress incontinence, a small piece of mesh might be placed underneath the urethra to support it and thus avoid its relaxation when the patient strains, coughs, laughs, or sneezes.
At the end of the surgery, a small camera is used to examine the inside of the bladder to make sure there were no injuries to the bladder during surgery. The surgery typically takes 2-3 hours to complete. Our patients usually return to routine activities in 2 weeks.
- Rectocele Repair
Rectocele repair (also called a posterior vaginal wall repair) is indicated when the last segment of the intestine (known as the rectum) bulges into or presses out through the posterior wall of the vagina. Because this is not a defect of the bowel wall, but rather of the pelvic supporting tissue, it is treated by repairing the weakened vaginal wall.
During this surgery, the surgeon pulls together the stretched or torn vaginal tissue in the area of prolapse. The vaginal wall is then reinforced with stitches to prevent prolapse from recurring. The stitches will be gradually absorbed by the body over time. The vagina is packed with gauze which is removed the day after surgery.
This procedure requires an overnight hospital stay. Blood thinners may be given to help prevent clots for several weeks following surgery. Our patients usually return to their normal routine in one to two weeks.
Advantages of a minimally invasive laparoscopic approach
While still considered major surgery, the minimally invasive laparoscopic approach offers several advantages over a vaginal approach or traditional open abdominal surgery, including:
- Shorter hospital stays (most of our patients go home the same day or next morning versus staying four days in hospital following an open abdominal surgery)
- Less pain
- Less blood loss because the surgeon works through small incisions with limited tissue disruption
- Less scarring (three tiny incisions versus a long vertical scar at the lower abdomen)
- Faster recovery and return to normal activities (our laparoscopic patients typically return to normal activities one to two weeks after surgery versus four to six weeks for open abdominal surgery patients)
- Fewer complications than open or transvaginal surgery
- The surgeon has a better view of the pelvic structures, resulting in less risk of damaging surrounding organs
- Better access to the pelvic organs from multiple angles
- Lower risk of prolapse recurrence than with an open abdominal or transvaginal approach
Are there any risks with laparoscopic prolapse repair surgeries?
Most operations are straightforward and without complications. However, all surgeries come with risk, no matter how small the probability, and this must be taken into account when considering surgery.
Risks associated with laparoscopic repair of prolapsed pelvic organs include:
- Damage to the bladder during surgery
- Damage to the intestine during surgery
- Excessive bleeding that might require conversion to open surgery to control
- Deep venous thrombosis (a blood clot in a leg vein following surgery)
- Implant complications (damage to pelvic structures caused by vaginal mesh material)
- Recurrence of the prolapse following repair
Are all laparoscopic prolapse repair surgeries performed the same way?
Absolutely not. Laparoscopic surgery requires highly skilled and experienced surgeons in order to be performed safely and with excellent outcomes. The fact is that a high degree of training and a large volume of cases is needed to master the laparoscopic technique. That is why so few OB-GYN surgeons offer these minimally invasive procedures.
Dr. Thais Aliabadi and Dr. Ramon Yera have performed thousands of minimally invasive laparoscopic procedures over two decades and have taught this surgical technique to colleagues throughout the U.S. and abroad.
Thus, women needing surgery to repair pelvic relaxation no longer need to face the prospect of:
- Putting their life on hold for many weeks while they recover
- Facing the risks of a long surgery
- Dealing with extended hospital stays
- Enduring a prolonged, painful recovery time with an increased risk of forming dangerous blood clots
- Living with disfiguring surgical scars associated with an open abdominal surgery
Choose minimally invasive outpatient surgery because your health and time are among your most important possessions.
Choose the Outpatient Hysterectomy Center for your Gynecological Surgical Care
If you are considering Pelvic Relaxation Surgery, you owe it to yourself to learn about the minimally invasive surgical treatment options available today.
Schedule a consultation today with our surgeons to have a thorough conversation about your particular condition, your reproductive goals, and to explore what surgical procedure might be most suitable for you.
If you wish to schedule a consultation to learn how we can help you or to establish care with us, please request a consultation online or call us at 844-541-7900.