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 Cystocele is when the bladder bulges into the vagina.
Rectocele Rectocele is when the end of the large intestine (rectum) pushes against and moves the back wall of the vagina.
Enterocele 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:
Childbirth The risk of prolapse is greater after vaginal delivery than after a C-section.
Surgery Surgeries such as a hysterectomy are a common cause of organ prolapse.
Aging 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.
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.
Understanding the Laparoscopic Treatment for Pelvic Organ ProlapseWhat 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:
Sacrocolpopexy 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)
Infection
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.
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The preoperative tests required for outpatient gynecological procedures usually include routine blood work, a physical examination, and possibly imaging tests like ultrasounds. Specific tests may vary depending on individual health status and the type of procedure planned. It's important to follow your doctor's recommendations for pre-op testing to ensure a successful surgery.
How is post-surgery pain managed?
After surgery, pain is managed with a combination of medications prescribed by the doctor. These may include painkillers, anti-inflammatories, and muscle relaxants. Patients are advised on proper dosage and timing to alleviate discomfort effectively. Additionally, using ice packs, resting, and avoiding strenuous activities aids in post-surgery pain management.
Are there dietary restrictions post-surgery?
Following pelvic prolapse surgery, a healthy diet is recommended to aid in recovery. Aim for high-fiber foods and plenty of fluids to prevent constipation. Limiting caffeine and alcohol can also promote healing. Consult with your healthcare provider for personalized dietary recommendations based on your specific surgery and health status.
What is the typical hospital stay duration?
Most patients go home the same day or the next morning, unlike traditional open abdominal surgery where a hospital stay of four days is common. Minimally invasive laparoscopic procedures offer faster recovery times, allowing patients to return to normal activities within one to two weeks.
How soon can normal activity resume?
Patients undergoing minimally invasive laparoscopic pelvic prolapse surgery typically resume normal activities within one to two weeks post-surgery. This approach offers faster recovery, less pain, and minimal scarring compared to traditional methods, facilitating a quicker return to daily routines for the patient's convenience and comfort.
Is sexual function affected post-surgery?
Sexual function can be impacted post-surgery due to the nature of the procedure and changes in pelvic anatomy. It's essential to discuss concerns with your doctor to address any potential effects on sexual function following pelvic organ prolapse surgery.
Are there non-surgical treatment alternatives?
Exercise techniques like yoga and stretching, but Kegel exercises may not help pelvic organ prolapse. Surgical options include open abdominal, transvaginal, or minimally invasive laparoscopic approaches. Laparoscopic surgery offers shorter hospital stays, less pain, and faster recovery with low prolapse recurrence risk.
What follow-up visits are necessary?
Follow-up visits after outpatient laparoscopic pelvic prolapse surgery are essential for monitoring recovery progress, checking for any potential complications, addressing concerns, and ensuring optimal healing. These visits provide an opportunity for the surgeon to evaluate your condition post-surgery and make any necessary adjustments to your care plan.
How can complications be minimized?
The outpatient laparoscopic approach minimizes complications by offering shorter hospital stays, less pain, and blood loss, along with faster recovery times. The minimally invasive technique provides better visibility for surgeons and lowers the risk of damaging surrounding organs, reducing the chance of prolapse recurrence compared to traditional surgery methods.
Is physical therapy required after surgery?
Physical therapy after surgery can be beneficial to aid in recovery, strengthen pelvic muscles, and improve overall function. Consult with your surgeon to determine if physical therapy is recommended based on your specific procedure and individual needs.
What are common surgery success indicators?
Surgery success indicators include shortened hospital stays, less pain, minimal blood loss, reduced scarring, faster recovery, lower complication rates, better visualization for surgeons, improved access to pelvic structures, and decreased risk of prolapse recurrence compared to traditional approaches. Minimally invasive laparoscopic surgeries offer these benefits.
How is bladder function assessed postoperatively?
Bladder function postoperatively is typically assessed through monitoring urinary output, checking for signs of urinary retention, evaluating for any signs of urinary tract infection, observing for any leakage or stress incontinence, assessing sensation during urination, and ensuring proper bladder emptying. These evaluations are crucial in determining postoperative recovery and assessing the success of the procedure.
Are there recommended lifestyle modifications?
For pelvic organ prolapse, exercises like yoga and stretching can help relax pelvic floor muscles. Kegel exercises are not typically effective. Surgical treatments such as laparoscopy offer benefits like shorter hospital stays, less pain, and faster recovery with minimal scarring. Schedule a consultation with surgeons to discuss the best option.
When can heavy lifting resume post-surgery?
Heavy lifting should be avoided for at least six weeks post-surgery to allow for proper healing. Overexertion too soon can increase the risk of complications and delay recovery. Consult with your surgeon for personalized guidance based on your specific procedure and recovery progress.
Is urinary incontinence risk increased post-surgery?
Following laparoscopic prolapse repair surgery, there is a lower risk of urinary incontinence compared to open or transvaginal procedures due to the minimally invasive approach's precision and reduced tissue disruption, resulting in less bladder and urethra trauma during surgery.
Can surgery be repeated if prolapse recurs?
Yes, surgery for prolapse can be repeated if it recurs. However, it's important to consult with your doctor to assess the specific situation and determine the most appropriate course of action. Repeat procedures may be considered depending on individual factors and the extent of the recurrence.
What patient education is provided pre-surgery?
Prior to surgery, patients receive detailed education about pelvic organ prolapse, the surgical procedures involved, non-surgical treatment options, the advantages of laparoscopic surgery, risks of the procedure, recovery timeline, and post-operative care instructions. This ensures informed decision-making and understanding of the process.
How are surgical incisions cared for post-surgery?
After surgery, clean incisions with mild soap and water, pat dry, and keep them covered with a sterile bandage. Avoid soaking in water until cleared by a healthcare provider. Follow specific care instructions provided by your surgeon for optimal healing and to prevent infection or complications.
What signs indicate surgery complications?
Signs indicating surgery complications include excessive bleeding, persistent pain, infection symptoms like fever, redness, or swelling, breathing difficulties, nausea, vomiting, and abnormal discharge. Additionally, signs such as fainting, confusion, chest pain, or persistent wound drainage may indicate the need for immediate medical attention.
Can surgery alleviate prolapse-related symptoms?
Surgery can effectively alleviate symptoms related to pelvic organ prolapse, providing relief from discomfort, fullness, and urinary issues caused by weakened support structures. Minimally invasive laparoscopic approaches offer advantages such as faster recovery, shorter hospital stays, and reduced scarring compared to traditional methods, enhancing the overall surgical experience and outcomes for patients.
How is bladder capacity affected post-surgery?
Bladder capacity post-surgery can be affected due to the repair exercises, urinary stress incontinence treatment, and rectocele repair provided. Minimally invasive laparoscopic procedures offer better outcomes, potentially impacting bladder function positively by addressing prolapse issues effectively.
Is catheter use required after surgery?
After surgery, catheter use may be required to help with urine drainage. The need for a catheter will be determined by your surgeon based on the type of procedure performed and individual circumstances. It is important to follow your surgeon's instructions regarding post-operative care.
How are bowel functions affected post-surgery?
After laparoscopic pelvic prolapse surgery, bowel functions can be affected, resulting in changes like constipation, needing to strain during bowel movements, or experiencing incomplete emptying. It's essential to discuss these potential outcomes with your doctor for proper post-surgery management.
What anesthesia options are available?
Various anesthesia options are available for outpatient laparoscopic pelvic prolapse surgery, including general anesthesia and regional anesthesia techniques like spinal or epidural anesthesia. The choice of anesthesia will be based on the patient's health status, surgical requirements, and preferences, to ensure a safe and comfortable procedure.
Can surgery interfere with future pregnancies?
Surgery for pelvic prolapse can interfere with future pregnancies due to the changes made in the pelvic floor during the procedure. Discuss reproductive goals with your surgeon to explore the best surgical option for you.
Is there a recommended surgery preparation regimen?
While specific surgical preparation regimens aren't listed on the page, patients are advised to schedule a consultation to discuss their condition, reproductive goals, and suitable surgical procedures directly with the surgeons. This personalized approach ensures individual health needs are appropriately addressed.
Are there specific postoperative activity guidelines?
Following outpatient laparoscopic pelvic prolapse surgery, specific postoperative activity guidelines may apply. It is essential to follow the surgeon's instructions carefully to ensure proper healing and minimize complications. Contact your healthcare provider for individualized guidance tailored to your recovery needs.
How is bladder support restored through surgery?
Bladder support can be restored through laparoscopic pelvic prolapse surgery. This procedure involves attaching surgical mesh to the vagina and securing it to a strong ligament in the front of the sacrum. The mesh supports the urethra to prevent leakage during activities like coughing or sneezing, enhancing bladder control.
Can constipation be prevented after surgery?
Constipation after surgery can be prevented by following post-operative care instructions, including adequate fluid intake, a high-fiber diet, early ambulation, and avoiding certain medications that may cause constipation. It is essential to communicate any concerns with your healthcare provider for tailored recommendations.
What are the criteria for surgery candidacy?
Surgery candidacy criteria include patients experiencing symptoms unresponsive to conservative treatments, those with significant pelvic organ prolapse impacting daily life, and individuals fully informed of surgical risks and benefits. Candidates should have realistic expectations, be mentally prepared, and understand the importance of post-operative care.
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