Pelvic Organ Prolapse: Surgery Issues

Major Factors

There are several major factors that are likely to increase the risk that the patient may have pelvic organ prolapse. First and foremost, is may appear owing to the fact that the patient’s muscles, pelvic fascia, and ligaments have weakened as a result of negative effects produced by hard pregnancy and delivery. Moreover, the patient’s age should also be taken into consideration. The second risk factor is high intraabdominal pressure (which may appear as a result of heavy lifting, chronic cough or straining), which, unless it is addressed in due time, also leads to prolapse. Finally, the same predisposition to the worsening of pelvic relaxation may be formed if the patient has atrophy (Vergeldt, Weemhoff, IntHout, & Kluivers, 2015).

Pelvic Organ Prolapse

It is not easy to identify pelvic organ prolapse as it shares its symptoms with a whole variety of other related conditions. The most commonly cited complaints of patients having pelvic organ prolapse include the feeling of something falling out or fullness in the pelvis. The difficulty of arriving at a correct diagnosis is also aggravated by the fact that most symptoms of the disease may be relieved when the patient lies down and rests after a prolonged period of standing or activity. Finally, anterior vaginal wall prolapse often leads to urinary frequency and urgency. Yet, one should not rely on this factor since in some cases prolapse may be associated with retention and incontinence (Gray, McVey, Green, Saxena, & Patel, 2016).

Types of Pelvic Organ Prolapse

There exist the following types of pelvic organ prolapse (Gray et al., 2016):

  • Apical vaginal prolapse–uterovaginal, vaginal vault (often appearing in patients who have undergone surgery);
  • Anterior vaginal prolapse–cystourethrocele, cystocele;
  • Posterior vaginal prolapse–enterocele, rectocele;
  • Complete procidentia designates the total prolapse of uterus.

Vaginal Estrogen

It cannot be claimed that vaginal estrogen plays a considerable role in patients with pelvic relaxation. Yet, it is rather important. First and foremost, pessaries may lead to vaginal irritation and even ulceration if the problem is neglected. If the vaginal epithelium is thoroughly nitrogenized, these conditions are easier to tolerate. Second, hypoestrogenic patients may need exogenous estrogen. However, it must be remembered that oral estrogen does not help treat and prevent pelvic prolapse (Vergeldt et al., 2015).

Reasons for Surgery

Surgery may be indicated for different reasons. For instance, one of the good reasons for recommending it is the presence of recurrent vaginal ulcerations or stress incontinence connected with the condition. Moreover, before accepting surgery, a person must consider several factors (Gray et al., 2016):

  • Surgery is rarely recommended to people of a young age as there is always a possibility that prolapse will recur and have complications. For the elderly, the operation is indicated taking into account prior surgeries and diseases.
  • Surgery is not an option for women planning childrearing since prolapse may return after the delivery.
  • Patients with heart diseases, diabetes, problems with breathing, or obesity are strongly advised to opt for non-surgical treatment as in their cases risks are much higher.

Avoiding the Surgery

In order to avoid surgery and its potential threats, a patient may try to resort to non-surgical treatment methods. Often the first suggested option it so inserts a pessary into the vagina enabling it to support the organs from the inside. For the same purpose, electronic devices and vaginal cones are used. A patient may also try doing some exercises to strengthen the pelvic floor. In the case of obesity, weight loss can help stabilize abdomen pressure (Gray et al., 2016).

References

Gray, T. G., McVey, S., Green, J., Saxena, A., & Patel, D. (2016). Pelvic organ prolapse. InnovAiT, 9(12), 723-731.

Vergeldt, T. F., Weemhoff, M., IntHout, J., & Kluivers, K. B. (2015). Risk factors for pelvic organ prolapse and its recurrence: A systematic review. International Urogynecology Journal, 26(11), 1559-1573.