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What are the latest treatments for grade IV pelvic prolapse? Any new pessaries?

By Anonymous June 26, 2009 - 3:55pm
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Age 71 with pelvic prolapse with pessary in place for over 10 years. Discussions with urogynecologist and gynecologist strongly recommended hysterectomy and ovary removal when doing corrective (sling) surgery. I have so far resisted. Don't like possible side effects of surgery--possible urinary and fecal incontinence. Sticking with pessary for now.

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Thanks so much for finding Empowher and for your question.

For readers who may not be up on what a grade IV pelvic prolapse is, or pelvic prolapse is, in general, here is a brief description of Pelvic Organ Prolapse (POP) from our Encyclopedia:

POP is a condition in which pelvic tissues are unable to support the uterus, rectum, bowel, urinary tract and bladder, so that those organs slide, bulge or push against each other.

What Causes POP?
The most common causes of prolapse are childbirth, aging and menopause, all natural events in a woman’s life cycle. POP can also be caused by diseases or conditions such as obesity, large fibroid tumours and spinal-cord injuries. Genetic predisposition can play a role, and pelvic surgery such as hysterectomy may also contribute. Even chronic coughing or heavy lifting can cause prolapse.

What Symptoms May I Encounter?
Many women will not notice any symptoms of prolapse. For those who do, lower backache or sensations of pulling and stretching in the pelvis and groin area can accompany the early stages of the condition. Once prolapse is more advanced, the most common and bothersome symptom is the bulging of the uterus into the vagina. It may not be sore, but it is uncomfortable. There may be a feeling of pressure, as though the vagina were falling out. Some women feel the frequent and/or urgent need to urinate as well, or experience constipation or other difficulties with the bowel. Vaginal spotting or bleeding may occur, and sex can become painful.

In severe prolapse, the pelvic organs can actually bulge outside of the vagina. The exposed tissue can become irritated, raw and infected. Severe prolapse can also cause urinary incontinence.

Anon - your stage 3 is the most serious stage, where your bladder is actually permanently outside your body, via the vagina.

Have you considered the surgery available to you? That does not include a hysterectomy?

Empowher has listed some great information regarding the surgery including before and after expectations. Here is some of that information:

Your physician will make an incision (cut) into the appropriate vaginal wall to expose the fascia and muscle underneath. He or she will then operate on this tissue to help strengthen it. In some cases, the tissue is sutured, or sewn, back onto itself in order to make it stronger. In others, a mesh-type material is used to strengthen the tissue. At this time, the doctor will also remove any tissue that has been weakened by previous surgeries, pregnancies, or age, as well as any excess vaginal lining.

If you have experienced severe incontinence problems, the doctor may also perform a suspension or elevation procedure to help support the bladder.

If the uterus is also prolapsing downward into the vagina, a hysterectomy may be done.

Typically, a bladder catheter will be inserted in your urethra at the beginning of the operation to help relieve pressure on the bladder.

After Procedure
◦If you had rectocele repair alone, the medicated vaginal packing is usually left in the vagina overnight, and the bladder catheter will be removed as soon as you are able to empty, usually before discharge from the hospital.
◦If you had cystocele repair, the medicated vaginal packing is also usually left in place overnight, but the bladder catheter often needs to stay in longer (sometimes 2-6 days) in order to allow the bladder time to begin functioning normally again.
◦You may notice a possibly smelly, even bloody, discharge from the vagina for 1-2 weeks.
How Long Will It Take?
The surgery itself can take anywhere from 45 minutes to 2 hours or more. The length depends on the repairs that need to be made.

Will It Hurt?
You will likely experience vaginal discomfort for 1-2 weeks following the surgery. You will typically be given a prescription for medication to help relieve this discomfort.

Possible Complications
Some risks associated with cystocele and rectocele repair include the following:

◦Adverse reaction to anesthesia
◦Heavy bleeding
◦Accidental damage to vagina, rectum, and bladder
◦Accidental damage to nearby organs

Accidental injuries during these procedures are extremely rare. In the unlikely event that an injury did occur, the doctor would usually fix the problem during the surgery.

Average Hospital Stay
Your hospital stay may range from 2-6 days or more. The length depends on your individual situation.

Postoperative Care
◦Avoid lifting anything that weighs more than 10 pounds for about a month.
◦Avoid sexual intercourse for about a month.
◦Avoid inserting anything into the vagina (eg, tampons) for about a month.
◦Have someone to help you at home for a few days following the surgery.
OutcomeTypically, women who have had cystocele or rectocele repair find that they have much improved bladder or bowel control.

Call Your Doctor If Any of the Following Occurs◦Any signs of infection, such as fever, chills, or foul-smelling discharge from the vagina
◦Unusually heavy vaginal bleeding
◦Worsening pain
◦Any unusual symptoms

Aside from the risk of needing a hysterectomy, have you looked into this surgery? I am in agreement with you (very much so!) that a hysterectomy should be your very last resort! Is the pessary no longer working for you?

June 26, 2009 - 4:45pm
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