Pelvic organ prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of prolapse in later life, but because many women don't seek help from their health care provider the actual number of women affected by prolapse is unknown. Prolapse may also be called uterine prolapse, genital prolapse, uterovaginal prolapse, pelvic relaxation, pelvic floor dysfunction, urogenital prolapse or vaginal wall prolapse.
Pelvic organ prolapse occurs when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs. The womb (uterus) is the only organ that actually falls into the vagina. When the bladder and bowel slip out of place, they push up against the walls of the vagina. While prolapse is not considered a life threatening condition it may cause a great deal of discomfort and distress.
Uterine prolapse is a condition that develops when muscular support for the uterus is lost and the uterus has fallen or dropped from its normal location, causing it to bulge into the vagina. The uterus is normally held in place by the pelvic muscles and supporting ligaments. When these muscles become weakened or injured, uterine prolapse can occur. In mild cases, a portion of the uterus descends into the top of the vagina. In more serious cases, the uterus may even protrude through the vaginal opening and outside the vagina. A prolapse can be associated with or accompanied by a urethrocele and cystocele (urethra and/or bladder bulge along the front wall of the vagina) and rectocele (rectal wall bulges into the back wall of the vagina).
TYPES OF PELVIC PROLAPSE
There are a number of different types of prolapse that can occur in a woman's pelvic area and these are divided into three categories according to the part of the vagina they affect: front wall, back wall or top of the vagina. It is not uncommon to have more than one type of prolapse.
Prolapse of the Anterior (Front) Vaginal Wall
- Cystocele (Bladder Prolapse): When the bladder prolapses, it falls towards the vagina and creates a large bulge in the front vaginal wall. It's common for both the bladder and the urethra (see below) to prolapse together. This is called a cystourethrocele and is the most common type of prolapse in women.
- Urethrocele (Prolapse of the Urethra): When the urethra (the tube that carries urine from the bladder) slips out of place, it also pushes against the front of the vaginal wall, but lower down, near the opening of the vagina. This usually happens together with a cystocele (see above).
Prolapse of the Posterior (Back) Vaginal Wall
- Enterocele (Prolapse of the Small Bowel): Part of the small intestine that lies just behind the uterus (in a space called the pouch of Douglas) may slip down between the rectum and the back wall of the vagina. This often occurs at the same time as a rectocele or uterine prolapse (see below).
- Rectocele (Prolapse of the Rectum or Large Bowel): This occurs when the end of the large bowel (rectum) loses support and bulges into the back wall of the vagina. It is different from a rectal prolapse (when the rectum falls out of the anus).
MoonDragon's ObGyn Information: Vaginal Hernias
Uterine & Vaginal Vault Prolapse (Apical or Top)
- Uterine Prolapse: Uterine prolapse is when the womb drops down into the vagina. It is the second most common type of prolapse and is classified into three grades depending on how far the womb has fallen.
- Grade 1: The uterus has dropped slightly. At this stage many women may not be aware they have a prolapse. It may not cause any symptoms and is usually diagnosed as a result of an examination for a separate health issue.
- Grade 2: The uterus has dropped further into the vagina and the cervix (neck or tip of the womb) can be seen outside the vaginal opening.
- Grade 3: most of the uterus has fallen through the vaginal opening. This is the most severe form of uterine prolapse and is also called procidentia.
- Vaginal Vault Prolapse: The vaginal vault is the top of the vagina. It can only fall in on itself after a woman's womb has been removed (hysterectomy). Vault prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.
Describing the Severity of a Prolapse
Most women, and their health care providers, describe the severity of a prolapse simply as mild, moderate or severe. There is, however, a grading system that uses numbers to describe the extent of a prolapse. In the past, the grading system for uterine prolapse (1, 2, 3) was also used for other types of prolapse. This was not technically accurate, and a new, more precise classification system has recently been developed.
The new grading system uses a series of measurements and is fairly complicated, but generally categorizes the severity of prolapse into stages I, II, III or IV. Stage I is mild prolapse. Stage IV is severe prolapse. Some health care providers may still refer to prolapse using the older classification of 1, 2 and 3.
FREQUENT SIGNS & SYMPTOMS
Women with mild prolapse may have no symptoms or discomfort at all and may not be aware they have a prolapse. When symptoms do occur, however, they tend to be related to the organ that has prolapsed.
A bladder or urethra prolapse may cause incontinence (leaking urine), frequent or urgent need to urinate or difficulty urinating.
A prolapse of the small or large bowel (rectum) may cause constipation or difficulty defecating. Some women may need to insert a finger in their vagina and push the bowel back into place in order to empty their bowels.
Women with uterine prolapse may feel a dragging or heaviness in their pelvic area, often described as feeling 'like my insides are falling out'. With severe prolapse, when the uterus is bulging out of the vagina, the skin may become irritated, raw and infected.
Symptoms that may occur with uterine or other types of prolapse:
- A lump in front or back of the vagina, or a lump that projects outside of the vagina.
- Abdominal discomfort or a feeling of heaviness in the vagina.
- Vague discomfort, pelvic pain, or pressure in the pelvic region.
- Backache that worsens with lifting. Lower back pain that eases when you lie down.
- Frequent and painful urination.
- Occasional stress incontinence (urine leakage when laughing, coughing, or sneezing).
- Difficulty in moving bowels.
- Pain or a lack of sensation with sexual intercourse.
- Excessive menstrual bleeding or abnormal vaginal discharge or bleeding.
- May not exhibit any symptoms at all in some women.
Prolapse occurs when muscles and ligaments at the base of the abdomen become extremely stretched, usually as a result of childbirth or aging. Women who have borne several children and/or who have gone through difficult and prolonged labor(s) are more prone to prolapse. Other factors that can increase the likelihood of uterine prolapse include obesity, uterine cancer, diabetes, chronic bronchitis, asthma, heavy lifting or straining (particularly if the pelvic muscles are already weakened), and a retroverted uterus (a uterus that is tilted toward the back of the body instead of towards the front of the body). Two-thirds of all women who prolapse do so before the age of 55 years.
RISK INCREASES WITH
Obesity. Women who are severely overweight are at increased risk of prolapse due to the extra pressure this creates in their abdominal area.
Pregnancy and childbirth is believed to be the main cause of pelvic organ prolapse - whether it occurs immediately after pregnancy or 30 years later. Some of the tissues that become damaged during pregnancy never fully repair their strength and elasticity.
One pregnancy and vaginal delivery can weaken the area enough to lead to prolapse eventually, especially if the birth was traumatic such as a prolonged intense pushing stage and not allowing tissues to stretch gradually, and/or the use of episiotomy, forceps, vacuum extraction. (No, a cesarean delivery will NOT prevent a prolapse at a later date!) There has been conflicting information about the effect of an episiotomy (a cut made in the base of the vagina during childbirth) may have on a woman's risk of prolapse, but the most recent research suggests it does not prevent pelvic floor damage.
Repeated pregnancy/childbirth stresses out and strains the pelvic muscles and ligaments. Women who have more than one child, whether the delivery is vaginal or by caesarean section, have a higher risk of prolapse than women who have one child or no children at all. Some people believe a cesarean section may be less damaging than a vaginal birth, but the majority of studies suggest that it is only slightly, if at all, protective. Studies also suggest that women who have children in close succession are at an even greater risk of prolapse because the muscles and ligaments are under constant strain.
Advancing age (gravity works!). Our muscles weaken as we age and grow older. The pelvic muscles are no exception. Although tissue damage is likely to have been caused much earlier, the aging process further weakens the pelvic muscles. The natural reduction of estrogen at menopause also causes muscles to become less elastic.
Conditions that cause increased intra-abdominal pressure such as fibroids or tumors. Women who are have large fibroids or pelvic tumors are at increased risk of prolapse due to the extra pressure this creates in their abdominal area.
chronic (long term) coughing from asthma, bronchitis, or from smoking or the chronic staining associated with constipation, increases a woman's risk of prolapse. A few occurrences of bronchitis or constipation are unlikely to have a serious effect on your pelvic muscles, but it the stress and strain is ongoing, it may eventually weaken the pelvic support structures.
Poor physical fitness. Lack of exercise with resulting weak muscles increases the risk of poor muscle tone in the pelvic region.
Occupations requiring heavy lifting can also strain and damage pelvic muscles and women in careers that involve regular manual labor or lifting, such as working in the nursing profession, have an increased risk of prolapse.
Previous pelvic surgery. Pelvic surgery, including hysterectomy or bladder repair procedures, may damage nerves and tissues in the pelvic area increasing a woman's risk of prolapse.
Spinal cord conditions and injury. Spinal cord injury and conditions such as muscular dystrophy and multiple sclerosis dramatically increase a woman's risk of prolapse. If the pelvic muscles are paralyzed or movement is restricted, the muscles waste away and cannot support the pelvic organs.
Ethnicity. Studies show that white and Hispanic women have the highest rate of pelvic organ prolapse, followed by Asian and black women. There is little information about the incidence of prolapse in women of other (or more specific) ethnic groups.
There are a number of things you can do to reduce your risk of prolapse or help prevent a mild prolapse from getting worse:
Maintain appropriate weight. If you are significantly overweight, try to lose weight. This will remove some of the pressure from your pelvic area.
One of the most effective things you can do to reduce your risk of prolapse is to exercise your pelvic floor muscles. Doing regular pelvic floor exercises (also called Kegel exercises) throughout your adult life helps keep the muscles toned and strong. Practice pelvic-strengthening exercises during pregnancy and after childbirth (Kegel exercises). Kegel exercises can tone the pelvic and vaginal muscles when prolapse is beginning and may prevent the condition from getting worse. Kegel exercise should be done as a part of your daily routine and can reduce your risk of both prolapse and incontinence in later life. These exercises can be done in two ways:
1. Tighten and squeeze the vagina and rectum by drawing the muscles inward and upward. Hold this position for five to ten seconds, then relax. Repeat as many times as possible, preferably at least 100 times a day.
2. When urinating, start and stop the flow of urine as many times as possible. This form of the exercise is particularly useful for stress incontinence.
Eat a normal, well balanced diet. Eat a high fiber diet (fresh fruits, vegetables, bran) to help prevent constipation and reduce straining.
Engage in a regular exercise program to maintain good muscle strength.
Avoid constipation. Make sure you consume plenty of fluids and fiber in your daily diet.
Estrogen therapy or hormone replacement therapy (HRT). If you are menopausal or post-menopausal, some health care providers may suggest you use hormone replacement therapy to protect against prolapse or prevent an existing prolapse from getting worse, but there is little scientific evidence to support the claim that HRT prevents prolapse. Before you make a decision about whether or not to use HRT, discuss the risks and benefits with your health care provider.
If you smoke, try to cut down or stop, as this will help reduce strain from coughing.
Do not lift heavy objects. This can damage your pelvic muscles.
Pelvic Floor Exercises (Kegel Exercises)
Pelvic floor exercises help prevent prolapse by strengthening the muscles that support the pelvic organs. The exercises are easy and quick to do, but it is important to do them correctly, and many women benefit from guidance from a physiotherapist.
Start by locating the muscles you need to exercise. There are a few different ways to do this:
- Place one or two fingers in your vagina and squeeze your muscles until you can feel your vagina tighten around your fingers. These are your pelvic muscles. Imagine you are trying to stop the flow of urine mid-stream. The muscles you tighten (contract) are your pelvic floor muscles.
- The other way to identify the correct muscles is to imagine you are trying to stop yourself from passing gas. The muscles you squeeze to do this are your pelvic muscles.
Once you have identified the correct muscles you are ready to begin. The exercises can be done while lying down, sitting or standing, with your knees together or slightly apart.
Set 1 - Slowly tighten your pelvic floor muscles and count to four, then let the muscles relax for a count of four. As your muscles get stronger gradually increase the count to 10. Try to repeat this 10 to 15 times.
Check that you are not tightening the muscles in your legs, abdomen or buttocks, as it is important to use only your pelvic muscles. Remember to keep breathing.
Set 2 - Now tighten and relax your pelvic muscles as quickly as you can, again 10 to 15 times.
As a preventive measure, try to do the exercises two or three times a day. If you have a prolapse, you may be advised to increase the number of times you do the exercises, but do not overdo it. Excessive exercising of the pelvic muscles can cause muscle fatigue and make the exercises less effective.
You can do the exercises anywhere, anytime, but studies show that when women do them at home, they are more likely to do them correctly. Some women find it helps to set aside specific times to do the exercises, such as before getting out of bed in the morning and before going to sleep at night.
If you think you are doing the exercises incorrectly or need help locating your pelvic floor muscles, a physiotherapist will be able to help you. Ask your health care provider for a referral.
Aggressive treatment is not always necessary because prolapse is not considered a health risk. Exercise can often improve muscle function. Severe prolapse can be cured with surgery.
Ulceration of the cervix.
Increased risk of infection or injury to pelvic organs.
Hemorrhoids from straining to overcome constipation.
Urinary tract obstruction.
SELF-DIAGNOSIS - BEFORE THE HEALTH CARE PROVIDER
If you have any of the symptoms of prolapse, particularly if you can see or feel something near or at the opening of your vagina, make an appointment to see your health care provider. Many women with prolapse avoid going to their health care provider because they are embarrassed or afraid of what their health care provider might find, but prolapse is very common and is nothing to be ashamed of.
Before you see your health care provider, it may help to make a list of symptoms, concerns and questions. Take the list with you to your appointment. It may be difficult at first to talk about your symptoms, and some women find the examination uncomfortable, but it only takes a few minutes and, by having your symptoms checked, you are taking an active role in your health and well-being.
Questions to ask your health care provider about your prolapse:
- What type of prolapse do I have?
- How severe is it?
- Do I need treatment and if so, what treatment do you recommend and why?
- What if I choose not to have any treatment?
- What can I do to ease the symptoms?
An intimate examination can be unnerving and many women (and men for that matter) find it difficult to remember everything that is said during the appointment, particularly if your health care provider uses technical terms. It may help to write down the answers to your questions.
WHAT TO EXPECT AT YOUR APPOINTMENT
To look for signs of prolapse your health care provider will need to do a thorough pelvic examination. If you prefer this to be done by a female examiner, ask for this when you make your appointment. You will be asked to undress from the waist down and lie on your back on the examination table. You should be given a blanket or sheet to put over yourself but if you are not, just ask for one. The health care provider will ask you to bend your knees and let them fall open. Some women find this position difficult, so if you cannot lie this way, say so. The health care provider can do the examination with you lying on your side with your knees drawn up in the fetal position. In fact, many health care providers will do this anyway when looking for prolapse as it is a good way to check the front and back walls of the vagina.
Your health care provider will feel for any unusual lumps or bumps in your pelvic area by inserting two fingers in your vagina and pushing gently on your abdomen. You will be asked if you feel any pain or discomfort. Tell the examiner if it hurts even if you are not asked. The health care provider may also insert a special speculum (called a Sims speculum) to examine the walls of the vagina for bulges.
You may be asked to cough or strain during the examination. This enables your health care provider to see if any urine leaks or if any of the pelvic organs prolapse into the vaginal walls. Some prolapse symptoms go away when you are lying down, so your health care provider may also want to examine you while you are standing.
If you have bowel symptoms, your health care provider may need to feel for bowel prolapse by placing one finger in your rectum and another in your vagina and asking you to strain or bear down. If you have urinary symptoms, your health care provider should take a urine sample to check for a urinary infection.
A good examiner/health care provider will explain what s/he is doing throughout the examination but if you have any questions, ask for an explanation.
If you have a mild prolapse that is not causing you any pain or discomfort, you do not need treatment. There are, however, some steps you can take to help improve your prolapse and prevent it from getting any worse, see Preventing Prolapse.
If you develop any new symptoms or your existing symptoms get worse, contact your health care provider. Because symptoms often develop gradually it may be difficult to judge when you should go back to the health care provider. There is no right or wrong answer, but as a general guideline, tell your health care provider if:
- Pain or discomfort is interfering with your daily activities.
- Sex becomes painful.
- You can feel or see something bulging out of your vagina or just inside your vagina.
- You have any unusual bleeding or discharge.
- You develop any of the other symptoms mentioned above.
If your prolapse is moderate or severe and is causing pain or discomfort, you should be referred to a gynecologist or urologist for further investigations and possible treatment. The specialist will ask you about your symptoms and health history and will examine you again to make sure the diagnosis is as precise as possible.
If you have bladder symptoms the specialist may do additional urine and bladder tests to check if the symptoms are related to your prolapse or separate from it. Incontinence will need to be treated in addition to treating your prolapse.
Diagnosing a Prolapsed Uterus: Uterine prolapsed is diagnosed through a detailed medical history and pelvic exam. Your health care provider will take measurements of the position of the uterus during the exam to assess the severity of the prolapse.
Uterine prolapse is typically graded on a 4-point scale with 0 being no prolapse (uterus is well supported) and 4 being the most severe prolapse (uterus protrudes from the vagina). Uterine prolapse classified as Stage II or greater is usually associated with symptoms that affect quality of life.
Although many women who experience symptoms from uterine prolapse fail to seek treatment out of fear or embarrassment, help is available.
Diagnostic tests may include pelvic examination, Pap smear, urinalysis, pelvic ultrasound or CT, endometrial biopsy and IVP (intravenous pyelogram - a method of studying the kidneys and urinary tract by injecting into the blood stream a medication that x-rays can detect). Most of the tests are to rule out other disorders.
LIVING WITH PELVIC ORGAN PROLAPSE
Living with prolapse can be a challenge, both physically and emotionally, as the symptoms can disrupt day-to-day life. Below are a few suggestions that may make living with a prolapse a little easier.
- Avoid standing for long periods of time. Many women find their symptoms get worse when they stand and improve when they lie down. Try to schedule in time to put your feet up. You could use the time to read, make to-do lists, write letters, talk with friends or just relax.
- Do pelvic floor exercises. These help prevent prolapse but can also help strengthen weakened muscles, aid recovery after surgical treatment and may help reduce symptoms such as leaking urine and back pain.
- Prevent or correct constipation. Eat a high fiber diet (fresh fruits, vegetables, bran) and drink plenty of water and other fluids to help prevent constipation and reduce straining.
- Wear a girdle. Some women find that wearing a tight girdle helps to reduce the heavy, dragging feeling in their pelvic area. However, wearing tight girdles, pants, belts or clothing can increase intra-abdominal pressure, which you want to avoid.
- Try yoga. Some women find yoga relieves some of the symptoms of prolapse, and it is a good (and gentle) way to stay fit. There are different types of yoga so find a class or group that suits you.
- Wear a panty liner or incontinence pad. If you occasionally leak very small amounts of urine you could use odor-control panty liners, but if you leak more, or frequently, you should use incontinence pads. They come in a range of sizes and are better suited to leaking urine than sanitary towels. If you notice the leaking is getting worse, contact your health care provider. Avoid pads that have been "scented" as these chemicals can aggravate existing incontinence problems.
- Explore alternatives to sexual intercourse. Moderate to severe prolapse may make sexual intercourse painful or uncomfortable, but there are many other ways to be sexually active, whether on your own or with your partner. Approach this as an opportunity to focus on new ways of finding sexual pleasure.
Carry wet wipes. If you have bladder or bowel symptoms, use wet wipes to keep yourself clean as well as reduce odor. There are different types available at drug stores and supermarkets, in a variety of fragrances, and in large or small packs that fit in your handbag. Unscented brands are preferable since the chemicals used for fragrance can cause irritation in some individuals. Clean gently around your genitals and do not use wipes with alcohol or harsh chemicals that may irritate the delicate skin in this area.
Deciding on treatment - Think about what you expect from treatment. What results would make a treatment successful for you? What would make you feel your treatment was a failure? Once you have your own answers to these questions, talk to your health care provider about your expectations and concerns.
There are a number of options available to treat prolapse, including physiotherapy, vaginal pessaries, and a range of surgical procedures. The choice of treatment depends on a variety of factors such as the type of prolapse you have, the severity of your symptoms, your age and other health issues, whether or not you want to have children in the future, and your personal preference. Before you decide on a treatment, talk to your health care provider about the risks, benefits and success rates of the treatments you are considering.
It may also help to talk with other women who have or have had prolapse. Keep in mind that every woman's situation is unique, and what is right for one woman may not be right for you.
There are a number of surgical and non-surgical options available to treat prolapse. The choice of treatment depends on a variety of factors such as the type of prolapse you have, the severity of your symptoms, your age and other health issues, whether or not you want to have children in the future, and your personal preference. Before you decide on a treatment, talk to your health care provider about the risks, benefits and success rates of the treatments you are considering.
If the prolapse causes no symptoms, no treatment may be needed, other than adopting an exercise program designed for the individual problem and situation.
A treatment plan depends on severity of prolapse, age, sexual activity, associated pelvic disorders, and desire for future pregnancy.
Women with mild symptoms can usually be treated with an exercise program (Kegel), hormone therapy, and pessary if needed. Others may need surgery. If you suffer from mild prolapse, doing kegel exercises to tone the pelvic floor muscles when prolapse is beginning may prevent the condition from getting worse. These exercises can be done in two ways:
1. Tighten and squeeze the vagina and rectum by drawing the muscles inward and upward. Hold this position for 5 to 10 seconds, then relax. Repeat as many times as possible, preferably at least 100 times a day (break them up into sessions of, as an example, 4 sessions with 25 kegels in each session, throughout the day.
2. When urinating, start and stop the flow of urine as many times as possible (until you get the hang of it). This form of the exercise is particularly useful for stress incontinence. However, once you have the method mastered, discontinue it during urination. Prolonged stopping and starting of urine may contribute to urinary retention and bladder infection.
Avoid wearing tight girdles, pants, belts or clothing that increases intra-abdominal pressure.
Do not strain during bowel movements or urination.
Natural progesterone replacement therapy may be more beneficial than estrogen therapy.
Herbal Remedies: ProgestaCare, Life-Flo, Natural Progesterone Cream For Women, 4 oz.
Herbal Remedies: Natural Progesterone Cream, Liposomal Lotion, NOW Foods, 3 oz.
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Herbal Remedies: Progesterone Therapy Supplements & Products
If your prolapse is mild to moderate, you may be referred to a physiotherapist for treatment. A physiotherapist will work with you to create an individualized treatment plan based on pelvic floor exercises. These exercises, also called Kegel exercises, may help keep the prolapse from getting worse and may help reduce backache, pelvic pain and incontinence. It may take a few months before you notice any improvement.
If you are unsure whether you are doing the exercises correctly, a physiotherapist may be able to help, either through coaching or by using a biofeedback machine.
MoonDragon ObGyn Procedures: Kegel Exercises
HORMONE REPLACEMENT THERAPY (HRT)
Women with prolapse who are experiencing, or are past, the menopause may benefit from HRT, either as a treatment on its own (for mild prolapse) or together with another treatment (for more advanced prolapse). Hormone replacement therapy may help strengthen the vaginal walls and pelvic floor muscles by increasing the estrogen and collagen levels in your body, but there is little evidence as to whether it is effective in treating prolapse. Before you make a decision about whether or not to use HRT, discuss the risks and benefits with your health care provider.
MoonDragon"s ObGyn Menopause Information: Hormone Replacement Therapy (HRT)
A vaginal pessary is a small device, similar to a diaphragm or cervical cap, which is inserted into the vagina to hold the prolapsed organ(s) in place. Pessaries are made of latex or silicone and come in many different shapes and sizes. Ring pessaries are the most common, but may not be right for every woman.
Pessaries are generally recommended as treatment for women who are waiting for surgery, women who are pregnant or want to have more children in the future, and women who are unable or choose not to have surgery.
Pessaries need to be individually fitted and you may need to try a few different shapes and sizes before you find one that feels comfortable and stays in place. Your health care provider should have a variety of pessaries for you to try. During your fitting, your health care provider will insert the pessary and ask you to walk around, sit, squat, cough and strain to test if it's comfortable and remains in place. If you feel uncomfortable doing this in front of your health care provider, ask for a minute or two of privacy while you test the pessary's staying power. Tell the health care provider if it does not feel right, even if it is the second, third or fourth pessary you have tried.
Once you have found the best fit, you will be asked to try it for a month or two before returning for a follow-up appointment. If you have any difficulties or concerns during this period, contact your health care provider for an earlier appointment. If your pessary is not working or is causing problems, you can either try a different pessary or a different treatment option entirely.
If the pessary is relieving your symptoms and you are not having difficulties with it, you will be scheduled for follow-up visits every 3 to 6 months. At your follow-ups the health care provider will remove the pessary, check whether it is causing any internal problems and whether your prolapse is getting worse, and will insert a new pessary. Follow-up visits are also a good opportunity for you to talk to your health care provider about any changes you have noticed or concerns you may have.
If your pessary becomes less effective at relieving symptoms you may need to be fitted with a different type or size. This is common. If you have any difficulties with the pessary or if you have any unusual discharge, bleeding or pain, contact your health care provider immediately - do not wait for your next appointment.
Questions to ask your health care provider about pessaries:
- What type of pessary do you recommend and why?
- Will it interfere with my sex life?
- Will it relieve all of my symptoms?
- What are the pros and cons of this type of pessary?
- How often does it need to be removed?
- Can I remove it myself in between appointments?
- How long can I use a pessary for?
Inserting, removing and cleaning your pessary - Recommendations about how often a pessary should be removed range from once a week (for an overnight period) to once every three months or more. In the United States, women are advised to remove, clean and reinsert their own pessaries on a regular basis. In the United Kingdom (UK), standard practice is for pessaries to be inserted and removed by the health care provider every 3 to 6 months. If you would like to have the option of removing and inserting your own pessary between your scheduled follow-up visits, talk to your health care provider about it. She or he should be able to teach you how to insert the pessary yourself. It will probably take a bit of practice to get used to placing it correctly and while some women may be comfortable with this, others may find it too difficult or too much of a nuisance.
Double pessaries for severe prolapse - Women with severe prolapse who do not want or are advised against surgery may be able to use two ring pessaries together. The double-ring technique is new but an initial study shows it relieves symptoms of severe prolapse, with the exception of rectocele and enterocele.
Things to consider before deciding to use a pessary - Some pessaries may interfere with sexual intercourse. A ring pessary may be left in place during sex - if it is comfortable for you - but other pessaries may literally get in the way. There is no published information about whether pessaries affect other sexual activity (such as oral sex) or a woman's ability to achieve orgasm. You (and your partner) may want to explore what is comfortable and pleasurable for you both.
Some women experience a bad-smelling discharge when they use a pessary. If this happens, contact your health care provider, as the pessary may be causing an infection. If a pessary does not fit right or is left in place for too long it can irritate the vaginal walls and cause raw, open sores (ulcers). If this happens, the pessary should be removed and estrogen cream applied to the vagina until the sores have healed.
Some people are allergic to latex or develop allergies after using latex products. Tell your health care provider if you think you have a latex allergy.
If you have any difficulties with your pessary, or have any unusual bleeding or pain, contact your health care provider.
TYPES OF PESSARIES
A pessary is usually a small ring-shaped device that is inserted into the vagina to help maintain the uterus in a normal position) may be prescribed. This approach can have undesirable results, however. It can interfere with sexual intercourse and may also cause irritating discharge with an unpleasant odor and even infection. Here are a selection of pessaries that are available:
Gehrung Pessary (HCPCS Code: A4562): The Gehrung pessary has wires that allow it to be manually shaped for different anatomies. It is used to support both cystoceles and rectoceles as well as second to third degree uterine prolapse. It is available in nine sizes. Because of the shapable wires, the Gehrung pessary must be removed during x-rays, ultrasounds and MRIs. The Gehrung pessary's flexibility and adaptability makes it an excellent choice for support of significant cystocele and rectocele, especially in cases of associated procidentia.
Folding Silicone Gehrung Sizes Available: GH50S #0, GH55S #1, GH60S #2, GH65S #3, GH70S #4, GH75S #5, GH80S #6, GH85S #7, GH90S #8
Ring Pessary (HCPCS Code: A4562): The ring pessary, available in nine sizes, both with and without support, is a very common pessary for a first to second degree prolapse. The Ring with Support can also be used on an accompanying cystocele. Insertion is eased with the folding action of the Ring. Not only does the EvaCare Ring pessary support a mild uterine prolapse and a cystocele, but it can also be helpful when used as a diagnostic device during urodynamic testing. The Ring can help to show what effect surgery may have as well as what type of surgery will be most beneficial for the patient. The pessary can act as a surgical facsimile predicting the need for anti-incontinence surgery.
Flexible Silicone Rings (w/ support) Sizes Available: R2.00S #1, R2.25S #2, R2.50S #3, R2.75S #4, R3.00S #5, R3.25S #6, R3.50S #7, R3.75S #8, R4.00S #9
Flexible Silicone Rings (w/o support) Sizes Available: R2.00 #1, R2.25 #2, R2.50 #3, R2.75 #4, R3.00 #5, R3.25 #6, R3.50 #7, R3.75 #8, R4.00 #9
Oval Pessary (HCPCS Code: A4562): The oval pessary performs the same function as the Ring pessary but it is designed specifically to fit a narrow vaginal vault. It is available in nine sizes, all with support, and is used for a first to second degree prolapse as well as an accompanying cystocele. The Oval pessary works extremely well in women with a prior history of vaginal surgery, resulting in scarring and in some cases, palpable sutures from anterior repair or bladder suspension procedures. Where a round pessary is too wide, the Oval pessary fits well and is comfortable and effective.
Flexible Silicone Oval Sizes Available: OV2.00S #1, OV2.25S #2, OV2.50S #3, OV2.75S #4, OV3.00S #5, OV3.25S #6, OV3.50S #7, OV3.75S #8, OV4.00S #9
Shaatz Pessary (HCPCS Code: A4562): The Shaatz pessary, available in nine sizes, is used for a first to second degree prolapse and an accompanying cystocele. The Shaatz pessary is versatile because it will help alleviate symptoms from uterine prolapse and cystocele. The convexity of its shape provides a snug fit. Additionally the design with the drainage ports allows easier removal by the patient who is dextrous enough to maintain her own pessary.
Flexible Silicone Shaatz Sizes Available: SH1.50 #0, SH1.75 #1, SH2.00 #2, SH2.25 #3, SH2.50 #4, SH2.75 #5, SH3.00 #6, SH3.25 #7, SH3.50 #8
Gellhorn Pessary (HCPCS Code: A4562): The Gellhorn Pessary is used for a second to third degree prolapse, or procidentia. It has drainage holes in its base and comes in nine sizes. The knob of the Gellhorn easily folds over for insertion, and once in place rests on the posterior vaginal wall. The Gellhorn pessary is often a health care provider's first choice for women with more advanced pelvic organ prolapse. It is easy to insert and remove, and allows for self-care. This device is also less likely to be expelled.
Flexible Silicone Gellhorn Sizes Available: G1.50D #0, G1.75D #1, G2.00D #2, G2.25D #3, G2.50D #4, G2.75D #5, G3.00D #6, G3.25D #7, G3.50D #8
Dish Pessary (HCPCS Code: A4562): The Incontinence Dish is used to relieve stress incontinence and minor degrees of prolapse. The Incontinence Dish comes with and without support. It is available in eight different sizes. The Incontinence Dish is designed to provide bladder neck support as well as to support a cystocele. It is easy to fit, stays in place and some patients have actually leave the health care provider's office dry.
Flexible Silicone Dish (w/ support) Sizes Available: DSH50S #1, DSH55S #2, DSH60S #3, DSH65S #4, DSH70S #5, DSH75S #6, DSH80S #7, DSH85S #8
Flexible Silicone Dish (w/o support) Sizes Available: DSH50 #0, DSH55 #1, DSH60 #2, DSH65 #3, DSH70 #4, DSH75 #5, DSH80 #6, DSH85 #7,
Hodge Pessary (HCPCS Code: A4562): The Hodge pessary has wires that allow it to be manually shaped for different anatomies. It can be used for a first to second degree prolapse, cystocele, stress incontinence and an incompetent cervix or uterine retroversion. It is available in ten sizes both with and without support. Because of the shapable wires, the Hodge pessary must be removed during x-rays, ultrasounds and MRIs. A Hodge pessary is often considered for a young, reproductive age woman with stress incontinence, who prefers conservative therapy.
Folding Silicone Hodge (w/ support) Sizes Available: HD65S #0, HD70S #1, HD75S #2, HD80S #3, HD85S #4, HD90S #5, HD95S #6, HD100S #7, HD105S #8, HD110S #9
Folding Silicone Hodge (w/o support) Sizes Available: HD65 #0, HD70 #1, HD75 #2, HD80 #3, HD85 #4, HD90 #5, HD95 #6, HD100 #7, HD105 #8, HD110 #9
Mar-Land Pessary (HCPCS Code: A4562): The Mar-Land is used for stress incontinence and minor prolapse. It is available both with and without support in seven different sizes. The Mar-Land pessary offers excellent support for moderate to extensive cystocele, as well as providing support for the bladder neck in managing stress incontinence.
Flexible Silicone Mar-Land (w/ support) Sizes Available: M2.25S #2, M2.50S #3, M2.75S #4, M3.00S #5, M3.25S #6, M3.50S #7, M3.75S #8
Flexible Silicone Mar-Land (w/o support) Sizes Available: M2.25 #2, M2.50 #3, M2.75 #4, M3.00 #5, M3.25 #6, M3.50 #7, M3.75 #8,
Donut Pessary (HCPCS Code: A4562): The donut pessary is designed for third degree prolapse as well as cystocele and rectocele. The soft donut can be compressed for insertion. It is available in seven sizes. Health care providers often use the Donut pessary on their patients with severe prolapse who are not immediately appropriate for surgery. It works well in a vaginal vault with little or no support, the type commonly found in older, post- menopausal women.
Flexible Silicone Donut Sizes Available: D2.00 #0, D2.25 #1, D2.50 #2, D2.75 #3, D3.00 #4, D3.25 #5, D3.50 #6
Cube Pessary (HCPCS Code: A4562): The Cube pessary is designed for third degree prolapse, including procidentia, as well as a cystocele and rectocele. The Cube pessary is available both with and without drainage holes and has a silicone tie to aid in removal. The Cube pessary is available in ten sizes. A Cube pessary may be used in women with either a very small or a large introitus due to its malleability. It is a very versatile pessary, but it should be used cautiously.
Flexible Silicone Cube (w/ drain) Sizes Available: CU25D #0, CU29D #1, CU33D #2, CU37D #3, CU41D #4, CU45D #5, CU50D #6, CU56D #7, CU63D #8, CU70D #9, CU75D #10
Flexible Silicone Cube (w/o drain) Sizes Available: CU25 #0, CU29 #1, CU33 #2, CU37 #3, CU41 #4, CU45 #5, CU50 #6, CU56 #7, CU63 #8, CU70 #9, CU75 #10
Fitting Set: The Fitting Set is a set of six different sizes of ring pessaries that can be used to determine the proper size of pessary for each patient. The Set comes with a cross reference chart that translates ring size into the correct size of other EvaCare pessaries. The Fitting Set can be disinfected in three ways: autoclaved, boiled or cold sterilized.
EvaCare Pessary Fitting Set CAT # FS 1000 QTY 1
PESSARY USAGE & FITTING GUIDELINES
TIPS ON FITTING A PESSARY
Fitting a pessary is more of an art than a science. A little experience and using the following tips will make selecting and fitting the right pessary quite easy. Although each style of pessary is unique, some basic fitting guidelines apply to all styles.
Some Guidelines: Cubes and Gehrungs usually are one size smaller than the selected ring. Gellhorns, Rings, Dishes, Donuts, and Shaatz pessaries are the size you measured with the finger technique.
Some of the most common pessaries and their uses are:
PRIMARY REASON FOR USING A PESSARY TYPES OF EVACARE PESSARIES TO CONSIDER Grade-Two Prolapse With Incontinence Dish Mar-Land
Hodge (with support) Second- To Third-Degree Prolapse Shaatz Cystocele or Rectocele Ring (with support) Gehrung
Hodge (with support) Primary Uterine Prolapse Gellhorn Fourth-Degree Prolapse Without Any Vaginal Tone Donut Cube
EvaCare® Pessary Guide
Cystocele Rectocele Stress
Ring X X YES Oval X X YES Shaatz X X YES Dish X X X YES MarLand X X X YES Gellhorn X X X NO Donut X X X NO Cube X X X NO Gehrung X X X YES Hodge X X X X X YES
Distributed by Mentor | Manufactured by Bioteque America, Inc.
Surgical measures may be necessary when the prolapse causes significant symptoms. Several methods are available and the choice will depend on a number of variables and the presence of associated conditions. Most of the surgical treatments for prolapse aim to lift the prolapsed organ(s) back into place. It is possible to surgically resuspend the uterus in its normal position. This procedure is usually performed on women who wish to bear children in the future. Hysterectomy (for uterine prolapse) is the only treatment that removes the prolapsed organ altogether. For women who have completed childbearing, or who do not wish to have children, vaginal hysterectomy is a viable option for this condition. The choice of surgery depends on the type of prolapse you have, your health, age, whether you want to keep your uterus or have children in the future, whether you are sexually active, the skills of your surgeon and your personal preference. If you're not happy with the surgery that has been recommended, talk with your health care provider about your concerns. If you are still not satisfied, or would like a second opinion, ask to be referred to another specialist. Women pondering a hysterectomy should give the matter close and careful consideration before opting for this procedure.
Questions to ask your health care provider about your surgical treatment options:
- Which surgery do you recommend and why?
- Will it be done vaginally or abdominally? If abdominally, will it be keyhole surgery (laparoscopy)?
- Who will do the surgery and how much experience does she or he have doing this procedure?
- What are the potential complications?
- How successful is the procedure?
- Will it relieve all of my symptoms? If not, which symptoms are likely to remain and what can be done about them?
- How might the treatment affect my sex life?
- Will the surgery treat all of my prolapses? (If you have more than one.)
- Do I need treatment for incontinence as well and will this be done at the same time? If yes, what is the procedure?
- What if I choose not to have surgery?
Before Surgery - Sex, older women and treatment options: Some health care providers may assume that older women are no longer sexually active and this can affect the range of treatments that are offered to you. If you are an older woman and are sexually active, or intend to be, make it clear to your health care provider that this is an important part of your life. Some treatments have a higher risk than others of leading to painful sex and one treatment, colpocleisis, closes off your vagina entirely, making sexual intercourse impossible.
Diagnosis: Before your surgery, you and your health care provider should be confident that your diagnosis is accurate. It is very common to have more than one type of prolapse at the same time and each one should be taken into consideration when planning treatment.
Tests: Your health care provider may give you a series of bladder tests before your operation even if you do not have bladder symptoms. This is because your prolapse may be masking stress incontinence by pushing against your urethra and preventing urine from leaking. Repairing your prolapse may fix one condition but leave you with another - incontinence. If you do have incontinence, it may be treated at the same time as your surgery for prolapse.
Estrogen Cream: If you are past menopause your health care provider may suggest you use estrogen cream temporarily for a month or two before and after your surgery. This helps to strengthen your vaginal and pelvic tissues and may improve the outcome of surgery.
Be Aware of the Possible Outcomes: As with all surgery, the degree of success depends on many factors. While surgical treatment may be successful for one woman, it may have very disappointing results for another. The surgical treatments listed below may repair your prolapse, but they may not relieve all your symptoms, and in some cases, they may make symptoms worse or cause other problems. Statistics show that about one in three women who have a surgical repair go on to have additional surgery.
Treating Prolapse of the Bladder & Urethra - Anterior Repair (Colporrhaphy): This procedure is used to treat prolapse of the bladder (cystocele), urethra (urethrocele) or both the bladder and urethra (cystourethrocele). The operation is done through the vagina and you will be given a general anaesthetic. It involves making a cut in the front (anterior) wall of the vagina so the bladder and/or urethra can be pushed back into place. Once this is done, the surgeon stitches together existing tissues to provide a new support for the bladder and urethra. A small portion of the vaginal wall is removed to give the vagina more strength. The main complications of anterior repair are painful sex (dyspareunia) and incontinence. Your surgeon may be able to reduce the risk of painful sex by making sure the vagina is not narrowed too much or pulled out of place during the repair. Incontinence can usually be prevented when diagnosed before surgery (see Before Surgery, above).
Repair with mesh - If you have had recurrent prolapse and this is not your first repair operation, mesh (synthetic or animal-based) may be used to help support the vaginal wall and keep the prolapsed organ(s) in place. This may provide better long-term support, but may also cause additional complications such as inflammation or erosion of surrounding tissues and an increased risk of painful sex.
Treating Prolapse of the Small Bowel & Rectum - Posterior Repair (Colporrhaphy / Colpoperineorraphy): Posterior repair is used to treat prolapse of the rectum (rectocele) and small bowel (enterocele). The operation is done through the vagina and you will be given a general anaesthetic. The procedure is similar to an anterior repair (above) but the practitioner may first make a small cut from the base of the vagina towards the anus (similar to an episiotomy during childbirth). This makes it easier for the repair to be done. A cut is then made in the back (posterior) wall of the vagina and the rectum and/or small bowel is pushed back into place. The practitioner stitches together the existing tissues to create a new support for the prolapsed organ(s) and then removes some of the tissue from the vaginal wall to make it stronger. If a cut was made at the base of your vagina, it will also be stitched back together. The main complication of posterior repair is painful sex (dyspareunia). Your surgeon may be able to reduce the risk of painful sex by not narrowing the vagina too much or pulling it out of place during the repair, but there is a high risk of experiencing painful sex after this procedure.
Repair with mesh - If this is not your first surgical repair, your health care provider may use synthetic or animal-based mesh to help strengthen the vaginal wall and hold the prolapsed organ(s) in place. While the use of mesh tends to provide long-lasting support, it may also cause surrounding tissues to become inflamed or eroded, and studies suggest it may increase the risk of painful sex.
Treating Uterine Prolapse: There are two surgical approaches to treating a uterine prolapse: removing the uterus altogether (hysterectomy) or lifting it and holding it in place (suspension).
1. Removing the Uterus (Hysterectomy): Hysterectomy (removal of the womb) is considered to be the most effective treatment for uterine prolapse. Despite this, it still may not relieve all of your symptoms and may lead to other health issues. A hysterectomy for prolapse is usually done through the vagina, but if your uterus is very large it may need to be removed abdominally. The procedure is done under general anesthetic and involves cutting the ligaments that hold the uterus in place, removing the uterus, closing off the top of the vagina and then shortening and reattaching the ligaments to hold the vagina up.
Hysterectomy is a major operation and after having this surgery: Women are at an increased risk of developing other types of prolapse, particularly vaginal vault prolapse. Some women feel less sensation during orgasm or have difficulty reaching orgasm. This may be due to nerve damage caused during the surgery. Also, for some women, the contractions of the uterus are a significant part of orgasm, and once the uterus is removed, the sensations become less intense. Women who have not yet gone through the menopause will no longer have periods or be able to get pregnant. If a woman's ovaries are removed during hysterectomy, she will experience a sudden menopause. Some women feel a profound sense of loss after their womb is removed. If you are unsure about whether to have a hysterectomy, take as much time as you need to make your decision. You may also want to get a second opinion about your treatment options.
MoonDragon's ObGyn Procedures: Hysterectomy - Abdominal
MoonDragon's ObGyn Procedures: Hysterectomy - Vaginal with Bladder/Rectal Repair (Vaginal Hysterectomy & Anterior/Posterior Colporrhaphy)
MoonDragon's ObGyn Procedures: Hysterectomy - Vaginal with Removal of Tubes & Ovaries & Bladder/Rectal Repair (Vaginal Hysterectomy with Bilateral Salpingo-Oophorectomy & Colporrhaphy)
2. Suspending the Uterus: Treatments that suspend rather than remove the uterus are recommended for women who want to keep their uterus or have children in the future. Procedures can be done either vaginally or abdominally, and there is some evidence to suggest that abdominal repairs tend to have better long-term results.
Sacrohysteropexy - This procedure uses a strip of synthetic mesh to hold the uterus in place. The operation is done abdominally, either through a 15 cm cut just above the pubic hairline or through keyhole surgery (laparoscopy). The doctor attaches one end of the mesh to the cervix and top of the vagina and the other to a bone (sacrum or sacral bone) near your spine. Once in place, the mesh supports the uterus. There are few complications associated with sacrohysteropexy but there is a risk that the mesh may wear away (erode) the surrounding tissues or cause an inflammation. In severe cases, the mesh may need to be removed. If you are planning to have children after the procedure, a pregnancy may damage the repairs and cause the prolapse to recur. To help prevent this, you may be advised to have a scheduled caesarean section rather than a vaginal birth.
Sacrospinous Fixation - This operation holds the uterus up by stitching it to one of the pelvic ligaments (called the sacrospinous ligament) using sutures only; no mesh. The procedure is done vaginally and is therefore less invasive than sacrohysteropexy, but also has lower success rates. While complications are rare, there is a risk of damage to the pudendal and sciatic nerves that can lead to severe pain in your legs, buttocks, genitals and pelvic area.
Manchester Repair - Manchester repair (also called Fothergill operation) is no longer commonly performed, but used to be the only surgical alternative to hysterectomy for treating uterine prolapse. The procedure is done vaginally and involves removing part of the cervix (which may be elongated) and pushing the uterus back into place by shortening the ligaments that support it. The operation has a high failure rate and many women require additional surgery, usually a hysterectomy. In addition, the entrance to the uterus may become either very narrow or very relaxed and this can cause problems during pregnancy and childbirth.
Treating Vaginal Vault Prolapse
Sacrocolpopexy: This procedure uses synthetic mesh to support the top of the vagina. During the operation, the practitioner stitches one end of the mesh to the top of the vagina and the other end to a bone near your spine (called the sacrum or sacral bone). It is done abdominally, either through keyhole surgery (laparoscopy) or a larger cut just above the bikini line. Sacrocolpopexy has a higher success rate than sacrospinous fixation (below). Complications are uncommon but there is a risk that the mesh may inflame or erode the tissue around it. If this is severe, the mesh will need to be removed. This is considered a major procedure and therefore may not be appropriate for women who are frail or in poor health.
Sacrospinous Fixation: This operation supports the vagina by attaching the vaginal vault to one of the ligaments in the pelvic area (the sacrospinous ligament). The procedure is done through the vagina and uses sutures only; no mesh. Complications are rare, but can include damage to the pudendal and sciatic nerves, causing severe pain in your legs, buttocks, genitals and pelvic area. Note: Following surgery you may have mild to moderate pain in your buttocks and down one thigh. This is normal but should get better within a month. If the pain does not go away or get better, tell your health care provider.
Tight (Anterior & Posterior) Repair: This procedure is rarely done. It involves removing a large amount of the vaginal tissue in order to tighten and support the vagina. The main complication of this operation is severe pain.
Colpocleisis (Colpectomy or Le Forts Procedure): Colpocleisis - vaginal closure - is another procedure that is rarely done. It closes off the vagina by stitching the front and back walls together, leaving two pencil-width channels on either side. The operation is performed vaginally and can be done using a local anesthetic or epidural. It is only offered as a treatment option for women who have severe prolapse, are too frail to undergo any other surgical treatment and are absolutely certain they don't ever want to have sexual intercourse again. Once the vagina is sewn up, penetrative sex is no longer possible, and a vault prolapse may still recur, falling through what remains of the vagina.
NovaSilk polypropylene mesh is a new synthetic mesh for the treatment of Pelvic Organ Prolapse. It is a soft, supple mesh that is used for the treatment of Pelvic Organ Prolapse (POP). NovaSilk is lighter than the leading polypropylene mesh, weighing only 21 g / m2 and provides multi-directional elasticity to enable optimal anatomical conformance. It is used in a variety of pelvic floor procedures, including cystocele, enterocele, rectocele, and vaginal vault prolapse. It can be used for a wide variety of patients including the elderly, the obese, and those with previous POP procedures
Axis Tutoplast Processed Dermis is a solvent-dehydrated, gamma-irradiated preserved human allogenous dermis. And from its omnidirectional fibers to its proprietary cleaning process-Axis dermis radiates strength in every direction. Consistent and reliable, Axis dermis is a product of the same high standards that have made Suspend® Tutoplast® Processed Fascia Lata a tissue surgeons have come to rely on and trust.
Proprietary Cleaning Process - The Tutoplast® cleaning process inactivates transmissible pathogens such as HIV, CJD and hepatitis. How? By thorough tissue cleaning, processing, dehydration and preservation. Dermis integrity is maintained. Collagen matrix is preserved. And all organic material is removed. Maybe that's why no known case of disease transmission, infection or rejection have ever been reported on any Tutoplast processed bioimplant.
SUSPEND & PELVIC FLOOR RECONSTRUCTION PROCEDURES
Cystocele - Anterior Repair - Cystocele is herniation of the bladder into the vagina. This condition is due to aging and weakening of the bladder and the vaginal wall. The arcus tendinus provides the connective tissue support for attaching Suspend in the cystocele procedure. Restoration of the natural anatomy is achieved through stabilization of the bladder, which alleviates pressure to the vaginal wall. The pain of dyspareunia may be relieved when the cystocele is repaired with Suspend tissue. The tissue strength of Suspend supports the bladder to help prevent a recurrence of prolapse. Suspend is integrated in the natural course of healing, creating a reinforced barrier.
Rectocele - Posterior Repair - Rectocele is herniation of the rectum into the vagina, which causes disruption of bowel function and pain. Aging and weakening of the rectum and vaginal wall are the main causes of this condition. Suspend tissue is placed in the rectovaginal space to provide support for recurrent rectocele. Normal bowel movements are achieved by positioning the rectum with Suspend in its natural position. The tissue strength of Suspend works in conjunction with the body's natural tissue to support the rectum in its correct position. Suspend creates a natural line of defense to prevent infection and a recurrence of prolapse. In the natural course of healing the body integrates the Suspend tissue implant, recreating the body's natural support for the rectum.
Vault Prolapse - Sacrocolpopexy - Sacrocolpopexy procedure is performed when the apex of the vagina descends from its anatomical position. This may occur in women following hysterectomy or because of the natural course of aging. Suspend tissue is attached to the sacrum and the vaginal cuff, which provides support for the vaginal vault. The strength of Suspend tissue does not narrow the vaginal vault; it simply stabilizes the apex and holds it in the correct anatomical position. Suspend tissue acts as a barrier of support, cradling the apex and holding it in its natural position above the vaginal vault. The new transplanted tissue works in conjunction with the body's natural tissue to create a reinforced barrier of support capable of preventing a recurrence of vault prolapse. Suspend tissue becomes a part of the body's natural anatomy.
RECOVERING FROM SURGERY
Most repair operations take about one hour, but you will need to stay in hospital for a few days. If the surgery is done vaginally, the area around your vagina will be tender and bruised. If you have a posterior (back) vaginal repair (for enterocele or rectocele), you may also have a few stitches at the base of your vagina. If your surgery is done abdominally, you will have a few stitches in your belly and it will be quite sore. To help ease the pain you will be given pain medication in tablets or injections and you may be given a device that lets you control the amount of pain medication you have. You will also have a drip in your arm to give you fluids.
You may have a catheter (a tube to remove urine) in place but this will probably be removed within a day or two. Your catheter may be attached through a cut in your abdomen even if you have had a vaginal procedure. Some women find it difficult to pass urine for a few days after the operation but this should improve gradually.
It is important to start moving as soon as possible after the operation. You will feel drowsy from the general anaesthetic, but start by lifting your head off the pillow, pointing and flexing your toes and sitting up for short periods. You may be seen by a physiotherapist, who will show you some exercises and teach you how to get out of bed and move around without hurting yourself, but if not, ask the nurse for help or ask to be referred to a physiotherapist.
Getting Better At Home: It will take about three months before you are fully recovered, but you may feel better after about six weeks. It is important to take it easy, even if you feel energetic, as your internal wounds will still be healing.
- Rest - get as much rest as possible and do not lift anything heavy (children, laundry, shopping bags, pets etc) for at least three months as this may damage the repair. Do not do any strenuous exercise (walking is fine) for about six weeks and try to take as much time as possible off work (including housework). If you live alone, try to arrange for someone to help with the cleaning and shopping for a few weeks after your surgery.
- Vaginal discharge - you may have a slight vaginal discharge for about six weeks. Some women notice threads in the discharge when the internal stitches dissolve. This is normal. Do not use tampons for about six weeks while your vagina is healing. Contact the health care provider if the discharge gets worse rather than better or if you have any unusual bleeding or pain.
- Sex - Do not have sexual intercourse for six weeks or until the vaginal discharge has stopped. If you are unsure about when it is safe to have sex again, contact your health care provider.
Evolution of Pelvic Surgery: The American Urogynecologic Society
By Anthony Tizzano, M.D., Marie Fidela R. Paraiso, M.D.
Estrogen therapy can increase blood flow to vaginal tissues and increase supporting tissue strength. Estrogen replacement therapy for postmenopausal women may help to build genital muscle strength and slow the rate of prolapse. However, hormone therapy may not be recommended because it poses an increase risk of developing certain types of cancer.
Natural progesterone replacement may be more beneficial than estrogen therapy.
Antibiotics will be prescribed if infection develops.
Avoid occupational or physical activities that increase intra-abdominal pressure.
If surgery is necessary, resume your normal activities gradually.
A weight loss diet and developing a plan for weight control is recommended if you are overweight.
MoonDragon's ObGyn Information: Obesity (Overweight)
MoonDragon's ObGyn Information: Obesity - Herbal Suggestions For Weight Loss
MoonDragon's ObGyn Information: Obesity - Holistic & Dietary Information
MoonDragon's Nutrition Information: Weight Loss Diet
MoonDragon's Nutrition Information: Weight Control Diet
Eat a diet high in fiber and/or a daily fiber supplement to prevent constipation. Drink 8 to 10 full glasses of quality water daily.
MoonDragon's Nutrition Information: High Fiber Diet
Herbal Remedies: Ultimate Fiber Powder, For Digestion & GI Cleansing, Sweet Citrus Burst, Nature's Secret, 7.9 oz.
Herbal Remedies: Psyllium Husk Powder, 100% Pure Bulk Fiber, Orange Flavor, Vegetarian, NOW Foods, 12 oz.
Herbal Remedies: Grapefruit Fiber, 100% Pure Powder, NOW Foods, 1 lb.
Herbal Remedies: Natural Fiber Supplement, Trumans, 12 oz.
Herbal Remedies: Apple Fiber, NOW Foods, 12 oz.
Herbal Remedies: Fiber Supplements & Products
Eat a diet consisting of 75 percent raw fruits and vegetables plus whole grains such as brown rice and millet.
Buchu and Cranberry aid in controlling bladder problems. Cranberry aids in bladder function and helps prevent urgency incontinence. It can be taken in capsule form. Pure, unsweetened cranberry juice is recommended. Pure, unsweetened cranberry juice is very tart, but very good.
Herbal Remedies: Cranberry Juice Concentrate, Natural Premium Quality, Kosher, Dynamic Health, 16 fl. oz.
Herbal Remedies: Cranberry Extract Supplement, Standardized, Vegetarian, 400 mg, 120 VCaps
Herbal Remedies: Cranberry Extract, Standardized, Vegetarian, Nature's Way, 400 mg, 120 Tabs
Herbal Remedies: Cranberry Fruit, Vegetarian, Nature's Way, 500 mg, 180 VCaps
Herbal Remedies: Urinary Supplement Formula With Cranberry Fruit, Nature's Way, 480 mg, 100 Caps
Herbal Remedies: Buchu Herb, Urinary & Kidney Herb, African Red Tea Imports, 2 fl. oz.
Herbal Remedies: Buchu Leaves Tincture, Alternative Health & Herbs Remedies, 2 fl. oz.
Herbal Remedies: Buchu Supplements & Products
Damiana provides oxygen to the genital area and balances female hormones.
Herbal Remedies: Damiana Leaves Powder, 4 oz. Bulk
Herbal Remedies: Damiana Supplement Tincture, 2 fl. oz.
Herbal Remedies: Damiana Leaves, NOW Foods, 450 mg, 100 Caps
Herbal Remedies: Damiana Leaves, Wild Mexican, Nature's Way, 400 mg, 100 Caps
Herbal Remedies: Damiana Leaves Supplements & Products
Ginger can help with bowel problems.
Herbal Remedies: Ginger Tea, Organic Digestive Aid, Yogi Tea, 16 Tea Bags
Herbal Remedies: Ginger Root Powder, 4 oz. Bulk
Herbal Remedies: Crystallized Ginger Slices, NOW Foods, 12 oz.
Herbal Remedies: Ginger Root, Nature's Way, 550 mg, 180 Caps
Herbal Remedies: Ginger Root Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Ginger Tea, 20 Tea Bags
Herbal Remedies: Ginger Supplements & Products
Nutrients Supplement Suggested Dosage Comments Essential Calcium 1,500-2,000 mg daily. Essential minerals needed for muscle tone and metabolism.
Calcium, Magnesium & Vitamin D, 100% Natural, Nature's Way, 250 Caps,
Just An Ounce Calcium & Magnesium, Almond Flavor Liquid, 16 fl. oz.,
Calcium Citrate / Malate Complex, Nature's Way, 500 mg, 250 Caps,
Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz.,
Liquid Calcium W/ConcenTrace, Orange Vanilla, Trace Minerals, 1000 mg, 32 fl. oz.,
Cal-Mag Pre-Chelated Calcium & Magnesium, Vital Earth, 240 Gelcaps
750-1,000 mg daily. Important in Calcium uptake.
Magnesium Ionic Mineral Supplement, Fully Absorbable, 350 +/- ppm, 16 fl. oz.,
Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.,
Calcium & Magnesium Mineral Complex, 100% Natural, Nature's Way, 500 mg / 250 mg, 250 Caps
As directed on label. A good source of necessary minerals and other nutrients.
Bone Strength, NOW Foods, 240 Caps,
Calcium Complex Bone Formula, Nature's Way, 100 Caps,
Bone, Flesh & Cartilage, Nature's Way, 100 Caps
L-Carnitine 500 mg twice daily, on an empty stomach. Improves muscle strength in the uterus.
L-Carnitine, Stable Tartrate Form, NOW Foods, 500 mg, 60 Caps,
L-Carnitine, Stable Tartrate Form, NOW Foods, 500 mg, 30 Caps,
Acetyl L-Carnitine Powder, Vegetarian, NOW Foods, 635 mg, 3 oz.,
L-Carnitine, Liquid Double Strength, NOW Foods, 16 fl. oz.,
L-Carnitine, Stable Tartrate Form, NOW Foods, 250 mg, 30 Caps,
L-Carnitine (Acetyl), NOW Foods, Pharmaceutical Grade, 500 mg, 100 Caps
500 mg twice daily, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg vitamin B-6 and 100 mg vitamin C for better absorption. Retards muscle degeneration.
L-Glycine Powder, Free Form, Vegetarian, 1 lb.,
DMG Supplement, N,N, Dimethyl Glycine, NOW Foods, 125 mg, 100 Caps
Branched-Chain Amino Acid Complex
As directed on label. Promotes healing of muscle tissue.
Amino 1000 Complete, NOW Foods, 120 Caps,
Amino 1500, Chewable Blend of 20 Amino Acids, Predigested, NOW Foods, 150 Tabs,
Spectrum Shake (Amino Acids), Original (Unsweetened vanilla), 1 lb, 4 oz.,
Spectrum Shake (Amino Acids), Vanilla, 1 lb. 3 oz.,
Branched Chain Amino Acids, Free Form, 120 Caps,
Branched Chain Amino Acid Powder, NOW Foods, 12 oz.
Methylsulfonylmethane (MSM) As directed on label. Do not exceed the recommended dose. A natural sulfur compound found in foods and present in body tissues. It is used by the body to build healthy new cells. MSM provides the flexible bond between the cells and provides support for tendons, ligaments, and muscles. Use a capsule form for easier absorption.
Liquid Glucosamine Chondroitin MSM, Joint Support Supplement, Trace Minerals, 32 fl. oz.,
MSM With Glucosamine, Pure Lignisul, 500 mg/500 mg, 120 Caps,
MSM Supplement, Pure Lignisul With Free 4 oz. Lotion, 1000 mg, 120 Caps,
MSM Supplement, Pure Lignisul, 1000 mg, 240 Caps,
MSM Liquid, Pure Lignisul, 16 fl. oz.,
MSM Powder, Pure Lignisul, 4 oz.,
MSM Supplement, Pure Lignisul, 500 mg, 250 Caps
Zinc 50 mg daily. Do not exceed a total of 100 mg daily from all supplements. Important for calcium uptake, bone support, all bodily enzyme systems, and immune function. Use zinc gluconate lozenges or OptiZinc for best absorption.
Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz.,
Zinc Chelate, 100% Natural, Nature's Way, 30 mg, 100 Caps,
Ionic Zinc, Trace Minerals, 50 mg, 2 fl. oz.,
Zinc Lozenges w/Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges,
Colloidal Silver & Zinc Lozenges, SilvaSolution, 90 Lozenges,
Elderberry & Zinc, Vegetarian Formula, Now Foods, 90 Lozenges
Multi-Vitamin & Mineral Complex
vitamin B complex
As directed on label. All nutrients work together for healing and tissue repair.
Completia Diabetic Multi-Vitamin, Iron Free, Nature's Way, 60 Tabs,
Damage Control Master Formula, High Potency Multi-Vitamin, 60 Packets,
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps,
Multi-Vitamin With Minerals, Hi-Tech, 90 Tabs,
Super Multi-Vitamin & Mineral Liquid, Pure Vital Earth, 98% Bio-Available For Absorption, 32 fl. oz.,
Multi-Vitamin & Mineral without Iron, Complete Vitamin Supplement, Nature's Way, 100 Caps,
Multi Vitamin & Mineral with Iron, Nature's Way, 100 Caps
Natural Carotenoid Complex
Carotenoid Complex: As directed on label.
Beta Carotene: 15,000 IU daily.
Needed for proper immune function. Build resistance to infection.
Beta Carotene (Natural Dunaliella Salina), Nature's Way, 100% Natural, 25,000 IU, 100 Softgels,
Multi-Carotene Antioxidant, Nature's Way, 60 Softgels
Vitamin C With Bioflavonoids 3,000-5,000 mg daily, in divided doses. Important for keeping bladder infections under control and to enhance immune function. Use an esterified from for best absorption.
Vitamin C Liquid w/ Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, Dynamic Health, 1000 mg, 16 fl. oz.,
Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs,
Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps,
The Right C, Nature's Way, 1000 mg, 120 Tabs,
Vitamin C 1000 w/ Rosehips, 100% Natural, 1000 mg, 250 Caps,
Electro C Powder, Vitamin C Supplement, Cherry Flavor, 1250 mg, 8 oz.
PROLAPSE OF THE UTERUS SUPPLEMENTS & PRODUCTS
Supplements and products for uterine prolapse, a condition that occurs when the pelvic muscles can no longer support the uterus.
Alive! Whole Food Energizer Multi-Vitamin & Mineral, w/ Naturally Occurring Iron (No Iron Added), Nature's Way, 90 Vcaps
No other supplement contains more life-giving nutrients than ALIVE! It is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands.
Buchu, Urinary / Kidney Herb, African Red Tea Imports, 2 fl. oz.
Buchu, the urinary herb, has traditionally been claimed to treat a wide variety of disorders, some of which include stomach complaints and urinary tract infections. Buchu is commonly used as a natural diuretic, thus assisting with relieving premenstrual bloating.
Cranberry Extract, Standardized, Nature's Way, 400 mg, 120 Tabs
Cranberry Extract with Ester is primarily useful for female adults and those with chronic or recurrent urinary tract infection. used to prevent urinary tract infection and relieve cramps and spasms. It also helps maintain a healthy urinary tract by inhibiting the adhesion of E. coli bacteria to the lining of the bladder. You can enjoy the benefits of cranberry without the added calories or sugar of a fruit juice.
Damiana Tincture, 100% Organic, 2 fl. oz.
Damiana is used to treat asthma and other respiratory diseases, depression, digestive problems, menstrual disorders, and various forms of sexual dysfunction such as impotence in men, and inability to achieve orgasm in women.
Female Regularity, Shenrong Dingkun, 60 Caps
Female Regularity, Shenrong Dingkun is made of ginseng, deer horn, carthamus, millettia, notoginseng, common peony root, prepared rehmannia root, Chinese angelica root, atractylodes, wolfberry, scute, cyperus, mother wort, cnidium, de-glued antler powder, donkey hide glue and corydalis.
Ginger Root, Nature's Way, 550 mg, 180 Caps
Ginger root is especially useful for bowel disorders including indigestion, morning sickness, motion sickness and nausea.
Just An Ounce, Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.
Just An Ounce, Calcium and Magnesium Liquid can help with the development of strong bones and teeth, also prevents muscle cramping, risk of colon cancer, maintain regular heart beat, protects against osteoporosis and helps relax the central nervous system.
L-Carnitine, Stable Tartrate Form, NOW Foods, 250 mg, 30 Caps
Pure L-Carnitine is an amino acid that normally attracts water which can cause it to deteriorate rapidly. We use a tartrate form to help ensure that NOW L-Carnitine maintains stability and full potency.
U O Clear (Ovarian Cyst & Fibroid Support), 500 mg, 60 Caps
The herbs work synergistically to strengthen the body's natural capability of female systems self-cleaning functions, especially for uterus and ovary.
Uterus Care, Balanceuticals, TCM Formula, 100% Natural, 60 Caps
Chinese medicine uses this well-known formula to tonify the kidney and control the Yin, enhance excitability and tension of the uterus smooth muscles, promote regular contraction of the uterus, maintain normal blood flow and avoid excessive uterus bleeding.
Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1,000 mg, 250 VCaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.
Zinc Lozenges w/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges
Nature's Way Zinc lozenge boosts cold season defense with zinc, widely recognized as an important nutritional support during the cold season, and echinacea pupurea, clinically shown to support the immune system, and Vitamin C, a vitally important vitamin for general health maintenance.
Herbal Remedies: Prolapse of the Uterus Information
Herbal Remedies: Prolapse of the Uterus Supplements & Products
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has symptoms of uterine prolapse.
Symptoms do not improve in 3 months despite treatment or exercise, or symptoms become intolerable and you wish to consider surgery.
The following occur if a pessary is fitted: Unusual vaginal bleeding, discomfort or difficulty in urinating.
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