Pelvic Relaxation / Prolapse

These problems are often referred to as a “dropped bladder” or “dropped uterus” and are actually the result of hernias in one or more layers of the pelvic floor.

There are many symptoms associated with these structural defects including pain, urinary leakage, difficulty urinating or difficulty with bowel movements. Symptoms can also include low back pain, pelvic pressure, pain with intercourse or sometimes tissue will bulge through the vaginal opening.

There are both surgical and non-surgical treatments for these hernias and the symptoms associated with them. Possible treatments include pelvic exercises, pessary devices as well as surgical repair.

Pessaries are ancient devices that have been found Egyptian mummies in the Pharo’s tombs and descriptions of pessaries can be found in medical treatises from the middle ages. These simple devices are worn inside the vagina and act as a structrual support. When correctly fitted they cannot be felt and are simple to use and care for. For an idea of what a pessary might look like visit Bioteque.

The traditional operations for “dropped bladder” have a well deserved reputation for failure, many of my patients have older relatives or friends who have had more than one operation for the problem often without good results. The old operations can be successful if they are carefully chosen and carefully performed.

Some of the older operations that used to be done through large abdominal incisions can be successfully performed today through very small incisions using the DaVinci Surgical Robot. Many of the newer surgical procedures for repair of the pelvic floor are substantially different from the older operations, often using a fine mesh implant to increase the strength of the repair.

Recovery from these operations today is easier and long term outcomes are much better. These operations have been available since the early 2000s and can also frequently be done as an outpatient procedure.

For more information about Pessaries visit:
UptoDate and type “pessary”in the search box.