Bard: Pelvic Organ Prolapse Bard: Pelvic Organ Prolapse An overview of An Pelvic overview Organ of Prolapse 1
Pelvic Organ Prolapse Throughout a woman s lifetime, her body undergoes tremendous stress. The strain of pregnancy. The effort of childbirth. Even the trauma of certain gynecologic surgeries such as hysterectomies. All of these stresses accumulated over the years can weaken the natural support structures of the pelvis, causing problems like pelvic organ prolapse, a feeling of vaginal fullness, chronic constipation and urinary incontinence. Any of these may require pelvic reconstructive surgery to repair. The symptoms of a weakened pelvic floor can range from mild to debilitating, and can affect your ability to lead an active life and even maintain sexual intimacy. There are many non-surgical and surgical options which can correct problems associated with pelvic organ prolapse, and help restore a better quality of life. What is Pelvic Organ Prolapse? The vagina and its surrounding structures (bladder, rectum, etc.) are attached to the pelvis by connective tissues. These tissues help form walls around the vagina and ensure that normal urinary voiding and bowel movements can occur. As the pelvic muscles become weak, the connective tissues can fail, allowing pelvic structures like the bladder or rectum to bulge into the vaginal wall. This can cause the following symptoms: A feeling of vaginal fullness, heaviness, or even pain Pain or discomfort during intercourse Loss of bladder control Involuntary urination or inconsistent urinary stream Difficulty with bowel movements Recurrent urinary infections 2
What causes Pelvic Organ Prolapse? Pelvic muscles and connective tissues which have been weakened with age are the primary causes, but many other factors may play a role. These may include vaginal childbirth, previous vaginal surgeries, menopause, smoking, diabetes, obesity, repeated heavy lifting, chronic coughing, and chronic constipation. Sometimes pelvic organ prolapse can be caused simply by genetic factors. What are the different types of pelvic organ prolapse? When vaginal prolapse occurs, an organ has dropped (prolapsed) out of its normal position and can sometimes even protrude from the vagina. The definition of pelvic organ prolapse is different depending on what anatomic structure in the pelvis is pushing into the vagina, such as the bladder or rectum. When vaginal prolapse occurs, the upper part (apex) of the vagina has dropped to a lower position. It is possible for more than one organ to prolapse into the vagina at the same time. Bladder Uterus Normal Anatomy Pelvic Bone Cervix Vagina Rectum Normal Female Anatomy The different types of pelvic organ prolapse: Cystocele Rectocele Enterocele Vaginal Vault Prolapse Uterine Prolapse 3
Cystocele (pronounced sis to-sel ) A cystocele occurs when the bladder falls into the vagina. As the connective tissue in the front wall (sometimes referred to as the roof) of the vagina fails, its attachment to the pelvis may be lost, allowing the bladder to drop into the vagina. This is the most common form of pelvic organ prolapse and is often called a dropped bladder. Cystocele Rectocele (pronounced rek to-sel ) A rectocele occurs when the rectum falls into the vagina. Similar to the cystocele, when the connective tissue in the rear wall (the floor) of the vagina fails, the rectum can then bulge into, or even out of, the vagina. As the rectum bulges upward, this can cause difficulty or pain during bowel movements. Rectocele 4
Enterocele (pronounced en ter-o-sel ) An enterocele occurs when the small intestines push the back of the vagina toward the opening. This usually occurs in conjunction with another form of prolapse and is repaired during the same procedure. Enterocele Vaginal Vault Prolapse In women who have had a hysterectomy (no longer have a uterus), the natural support structures in the vagina provided by the uterus no longer exist. The top portion of the vagina can then push down into the lower vagina, causing vaginal vault prolapse. Vaginal Vault Prolapse 2009 Tim Peters and Company, Inc. All Rights Reserved. Developed in consultation with Patrick Culligan, MD. 5
Uterine Prolapse For women who still have a uterus, the support structures holding the uterus in place can also be compromised, allowing the uterus to fall down into the vagina. This is called uterine prolapse. Uterine Prolapse How is Pelvic Organ Prolapse Treated? The best treatment for a specific type and severity of pelvic organ prolapse will vary from patient to patient. If your symptoms are mild, the doctor may recommend lifestyle changes, Kegel exercises to strengthen the pelvic muscles, or the use of a pessary to relieve the symptoms. When the symptoms are severe enough to affect your quality of life, your physician may recommend surgery. 2009 Tim Peters and Company, Inc. All Rights Reserved. Developed in consultation with Patrick Culligan, MD. Be sure to speak with your doctor about today s treatment options and choosing the one that is right for you. 6
Non-Surgical Treatments Kegel Exercises Your physician may suggest an exercise program of repeated contractions of the muscles of the pelvic floor. These muscles are identified as those that can be used to halt the flow of urine. Routine exercising of these muscles will help to build strength and maintain elasticity in the pelvis. Pessary Devices A pessary is a device that is worn in the upper portion of the vagina similar to a diaphragm, and is designed to support the surrounding tissues. Your physician will determine the appropriate size and design of the pessary that will best support your prolapse. Surgical Treatments Traditionally physicians have used sutures to sew weakened tissues back together. Sometimes, a piece of graft material (man-made or natural tissue) can be used to reinforce these repairs. 7
Sacrocolposuspension / Sacrocolpopexy For treatment of prolapse at the top of the vagina (vaginal vault or uterine prolapse), a sacrocolposuspension / sacrocolpopexy is a common treatment. It involves attaching the top of your vagina to a piece of graft material which is then secured to the top of your tailbone (bottom of your spine). This procedure can be done using either an open or minimally invasive approach. Vaginal Vault or Uterine Prolapse repair with graft (Sacrocolposuspension / Sacrocolpopexy) 8
Are there risks with a procedure using synthetic mesh materials? As with any surgical procedure, the prolapse repair procedure itself has the risk of certain complications such as the use of anesthesia, the surgical approach used, and how pre-existing conditions may affect the outcome. Your physician can further explain your specific risks and can provide a list of warnings associated with the procedure. The synthetic mesh may strengthen the repair, although results vary from patient to patient. In addition, there are risks associated with the use of a permanent synthetic mesh. There is a risk that the mesh material will protrude into the vagina causing difficulty and pain with sexual intercourse. Complications can also include localized fluid collection (blood, pus, clear serous fluid), erosion of the graft into surrounding tissues, infection, inflammation, pain, tightening of the repair (resulting in pain), perforation of neighboring tissues or organs, urinary incontinence and recurrence of vaginal wall prolapse. Given the permanency of synthetic mesh, post-procedure removal of the implant may be difficult. Additionally, repair of prolapse using synthetic mesh materials should not be undertaken if you are pregnant or may become pregnant. Specifically related to the Alyte Y-Mesh Graft, the effectiveness of this product has not been validated by a prospective randomized clinical trial. If you experience any complications, please notify your physician immediately. Speak with your physician regarding his/her experience with this procedure, and the anticipated probability of any of these complications. 9
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Regaining Control. Restoring Quality of Life. This brochure is not intended as a substitute for professional medical care. Only your physician can diagnose and appropriately treat your symptoms. C. R. Bard, Inc. Covington, GA 30014 www.bardmedical.com Bard and Alyte are registered trademarks of C. R. Bard, Inc. Please consult product inserts and labels for any indications, contraindications, hazards, warnings, cautions and instructions for use. 2011 C. R. Bard, Inc. All Rights Reserved. Printed in U.S.A. 1101-28 R03/11 THP P04/14 2.5M 12