Pelvic Organ Prolapse Treatments
- Avoid standing for long periods of time.
- Avoid heavy lifting.
- Keep your bowel movements soft using a high fiber diet.
- Use of Pessaries: A pessary is a small device made of plastic or silicone that is placed inside the vagina to hold the uterus or the walls of the vagina up, and inside of your body.
- Pelvic floor muscle training (Kegels): There are muscles around the vagina that help with pelvic support.
There are many different types of surgeries to correct pelvic organ prolapse. Often, more than one of these surgeries will be performed at the same time.
In general, vaginal approach surgeries have a faster recovery time and cause less pain than abdominal surgeries.
- Vaginal Hysterectomy - the removal of the uterus through the vagina, without any incision on the abdomen. Removal of the tubes and ovaries may be done at the same time.
- Anterior Repair (Anterior Colporrhaphy) - An anterior repair is a vaginal surgery to correct a cystocele, when the "upper" wall of the vagina that is in contact with the bladder is sagging down, or coming outside of the vaginal opening. This is done by making a vertical incision in the skin of the vagina, and folding the strong tissues just underneath the vaginal skin.
- Posterior Repair (Posterior Colporrhaphy) - A posterior repair is a vaginal surgery to correct a rectocele, when the "lower" wall of the vagina that is in contact with the rectum is bulging into the vagina, or coming outside of the opening of the vagina. This is done by making a triangular or diamond-shaped incision, and removing some of the extra skin of the wall of the vagina.
- Sacrospinous Ligament Suspension - A sacrospinous ligament suspension is used to re-attach the "top" or "apex" of the vagina when it has come down. This operation attaches the vagina to the sacrospinous ligament through the vagina.
- Uterosacral Ligament Suspension- used to re-attach the "top" or "apex" of the vagina when it has come down.
- Colpocleisis (vaginal shortening)- used for women who do not desire future vaginal intercourse and/or are in poor general health. The skin is removed from the vaginal bulge, and then the tissue is progressively sutured upon itself using many layers. The vagina will no longer be deep enough to permit intercourse.
In general, abdominal approach surgeries have a longer recovery time and generally cause more discomfort pain than vaginal surgeries.
- Hysteropexy (Uterine Sparing) - An incision is made on the abdomen (either transverse or vertical), and the uterus is supported by mesh with stitches that are attached to the front of the tail bone (sacrum).
- Supracervical Hysterectomy with Sacrocolpopexy -The uterus is removed by making an incision on the abdomen. A supracervical hysterectomy is different from a total hysterectomy in that the lower part of the uterus, the cervix, is not removed.
- Abdominal Sacrocolpopexy - An incision is made on the abdomen (either transverse or vertical), and a mesh is used to attach the top of the vagina to a strong ligament that lies along the sacrum, which is part of the pelvic bone.
- Laparoscopic Reconstructive Surgery - The abdominal surgeries can also be performed laparoscopically, through several very small (1 cm) incisions, with the use of a video camera. Abdominal sacrocolpopexy, paravaginal repair, and uterosacral ligament suspension can be done with the laparoscope. One advantage of laparoscopic surgery is that recovery time is faster than with abdominal surgery, and postoperative pain is usually less than abdominal approach surgeries.
- Robotic-Assisted Laparoscopic Surgery - A newer technology in laparoscopic surgery is robotically assisted laparoscopic surgery with the DaVinci robot. Abdominal sacrocolpopexy can be performed by the robot-assisted laparoscopic approach. Similar to standard laparoscopy, this procedure is performed through several very small (1 cm) incisions, with the use of a video camera. The advantage of this approach is faster healing time and shorter hospital stays than with a more traditional abdominal approach to the same surgery which is performed through a larger abdominal incision.
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