Pelvic Organ Prolapse

Cystocele and Rectocele

The pelvic floor is a group of muscles and tissues that support the bladder, bowel, and other organs in the pelvis. When these muscles and tissues weaken, the organs can bulge into the vagina, a condition known as a cystocele or rectocele. They are, in fact, pelvic hernias.

What is a cystocele?

A cystocele is a bulge in the bladder support tissues of the anterior vagina, a herniation, that pushes the bladder into the vagina. This can cause a feeling of pressure in the vagina, difficulty emptying the bladder, and urinary incontinence.

What is a rectocele?

A rectocele is a bulge through the rectovaginal septum, a herniation. that pushes the rectal tissues into the vaginal floor. This can cause a feeling of pressure in the vagina, difficulty evacuating the bowels, and constipation.

Either can cause a discomfort with intercourse, as well.

What causes cystocele and rectocele?

The most common cause of cystocele and rectocele is childbirth. The trauma from the baby's head on the pelvic floor can weaken the muscles and tissues. Other causes of cystocele and rectocele include:

• Aging
• Menopause
• Pelvic surgery such as hysterectomy
• Chronic constipation
• Lifting heavy objects

How are cystocele and rectocele diagnosed?

Your gynecologist will perform a detailed pelvic exam to diagnose cystocele or rectocele. 

How are cystocele and rectocele treated?

The treatment for cystocele or rectocele depends on the severity of your symptoms. Mild cases may be treated with lifestyle changes. Pessaries can be ordered and placed, and managed by the paitent, specific to each problem. More severe cases may require surgery.

Lifestyle changes

There are a few lifestyle changes that can help to improve symptoms of cystocele and rectocele (Remember, though, that once the hernia has formed, you might improve symptoms, but the hernia wil not go away without surgery):

• Pelvic floor exercises: These exercises can help to strengthen the muscles and tissues that support the bladder and rectum. 
• Weight loss: If you are overweight or obese, losing weight can help to reduce pressure on the pelvic floor.
• Avoiding heavy lifting: Lifting heavy objects can put stress on the pelvic floor, so it is important to avoid lifting heavy objects.

Surgery

Surgery is usually recommended for people with bothersome symptoms that do not respond to other treatments. There are a few  types that can be used to repair cystocele or rectocele.

• Anterior or posterior repair: This is the most common type of surgery for cystocele and rectocele. It involves repairing the weakened muscles and tissues at the vaginal ceiling (cystocele) or floor (rectocele).
• Sacrocolpopexy: This surgery involves attaching the bladder or rectum to the sacrum, which is a bone at the base of the spine.

Recovery from surgery

Recovery from surgery for cystocele is usually easy, with minimal pain, but no heavy lifting or intercourse for 6 weeks. Rectocele involves more pain in the first 2 weeks, and also takes 6 weeks.

The outlook for cystocele and rectocele is generally good. With treatment, women are able to relieve their symptoms and improve their quality of life.

Uterine Prolapse: What You Need to Know

Uterine prolapse is a condition in which the uterus descends from its normal position in the pelvis and bulges toward the vaginal opening. It is a common problem, affecting up to 1 in 5 women over the age of 50.

What causes uterine prolapse?

The pelvic floor muscles and tissues that support the uterus weaken, and the uterus can bulge into the vagina. There are a number of factors that can contribute to weakening of the pelvic floor, including:

• Childbirth: The trauma from the baby's head on the pelvic floor during childbirth can weaken the muscles and tissues.
• Aging: The muscles and tissues of the pelvic floor naturally weaken as we age.
• Menopause: The loss of estrogen during menopause can also weaken the pelvic floor.
• Other medical conditions: Conditions such as chronic constipation, obesity, and chronic cough can put stress on the pelvic floor and increase the risk of prolapse.

What are the symptoms of uterine prolapse?

The symptoms of uterine prolapse can vary from woman to woman. Some common symptoms include:

• A feeling of pressure in the vagina
• A bulge in the vagina (often the cervix)
• Difficulty emptying the bladder
• Urinary incontinence
• Discomfort with intercourse

How is uterine prolapse diagnosed?

Your gynecologist will perform a physical exam to diagnose uterine prolapse. They may also order a pelvic ultrasound or urodynamic testing to complete the work up.

How is uterine prolapse treated?

The treatment for uterine prolapse depends on the severity of your symptoms. Mild cases may be treated with lifestyle changes. More severe cases may require surgery.

Lifestyle changes

• Pelvic floor exercises: These exercises can help to strengthen the muscles and tissues that support the uterus.
• Weight loss: If you are overweight or obese, losing weight can help to reduce pressure on the pelvic floor.
• Avoiding heavy lifting: Lifting heavy objects can put stress on the pelvic floor, so it is important to avoid lifting heavy objects.

Surgery

Surgery is usually only recommended for people with symptoms that do not respond to other treatments. Pessaries can be used in certain individuals.  There are a few different types of surgery that can be used to repair uterine prolapse.

• Round ligament shortening.  This can work well if a patient has not completed childbearing.
• Hysterectomy: This is the most common type of surgery for uterine prolapse. It involves removing the uterus.
• Sacrocolpopexy: This surgery involves attaching the uterus, or the remaining vaginal cuff, to the sacrum, which is a bone at the base of the spine.
• LeFort Procedure:  This is for women who will not be sexually active in their future.  It permanently pulls up the uterus and essentially closes the vaginal canal so the uterus cannot prolapse.

Recovery from surgery

Recovery from surgery for uterine prolapse typically takes 2-3 weeks. You may experience some pain and discomfort during the recovery period. 

The outlook for uterine prolapse is generally good. With treatment, women are able to relieve their symptoms and improve their quality of life.

If you are experiencing symptoms of cystocele, rectocele, or uterine prolapse, it is important to see your doctor. Dr. Richmond performs all of the above treatments and surgeries on a regular basis.  If you feel you need evaluation or want to discuss treatments, call Special Care for Women at 256-435-2229 and make your appointment with Dr. Richmond!