Prolapse - Uterine or Vaginal

Some women experience prolapse (falling) of a pelvic floor organ, such as the vagina or uterus. This occurs when the connective tissue or muscles within the body cavity weaken and cannot hold the pelvis in its proper place.

At The University of Vermont Medical Center, we combine compassion and expertise, diagnosing and treating vaginal or uterine prolapse quickly and effectively.

Uterine or Vaginal Prolapse Care at UVM Medical Center

Doctors at The UVM Medical Center use a collaborative approach to treating uterine and vaginal prolapse. Your team may include a number of different specialists working together to manage your care.

• Advanced technology - We use the most sophisticated medical technology available for diagnosing and treating pelvic floor prolapse, including performing the advanced robotic-assisted sacrocolpopexy. This minimally invasive procedure reduces scarring and recovery time.
• Personalized care - The UVM Medical Center doctors tailor a course of treatment specifically for you. Your treatment will depend on a number of factors, including the severity of the prolapse and your personal preferences.
• Experienced expertise - Our gynecologists have years of experience diagnosing and treating uterine and vaginal prolapse. You can feel confident knowing you have placed your care in experienced and skilled hands.

Uterine or Vaginal Prolapse: An Overview

Muscles in your pelvic floor hold your organs in place. The weakening of these muscles leads to organ prolapse, a feeling that the organs are falling out. Women experiencing pelvic organ prolapse may also have problems with urinary or sexual dysfunction and incontinence. The weakening of the connective tissue accelerates due to:

• Age
• Childbirth
• Weight gain
• Strenuous physical labor

In addition, you are at higher risk if you have:

• A chronic cough
• Undergone prior pelvic surgery
• Chronic constipation
• Chronic obstructive pulmonary disease (COPD)

It is not always possible to prevent prolapse, but you can decrease your risk by preventing constipation, maintaining a healthy weight and performing Kegel exercises to strengthen your pelvic floor muscles.

Prolapse Diagnosis

If you experience symptoms such as urinary problems or a feeling that organs are falling out of your vagina, make an appointment with your doctor. Sometimes, prolapse does not require treatment.

However, if the symptoms are interfering with your life and disrupting your normal activities, expert physicians at the UVM Medical Center can help. Getting an accurate diagnosis is the first step to proper treatment.

Usually, a comprehensive pelvic exam and discussing your symptoms are all we need to confirm a diagnosis. Imaging exams are usually not necessary, though we may use them to determine how severe the prolapse is.

Your doctor will examine your pelvic area. In order to confirm a diagnosis, we will most likely ask you to lie down and stand up so we can examine you from various angles. We may also ask you to:

• Bear down as if having a bowel movement, to help us determine how far the uterus has slipped
• Tighten your pelvic muscles as if you are stopping urine, so we can evaluate the strength of the muscles

We will discuss your symptoms with you in-depth. We want to determine how the prolapse is affecting your quality of life in order to plan the most effective treatment for you.

Prolapse Treatments

Some prolapse requires no treatment, and some can be corrected through surgery. Your doctor will discuss treatment options with you so that you can make the choice that is right for your lifestyle.

One of the most common treatments for prolapse is sacrocolpopexy. Sacrocolpopexy is a procedure to surgically correct vaginal vault prolapse where the mesh is used to hold the vagina in the appropriate anatomical position.

This procedure can also be performed following a hysterectomy to treat uterine prolapse to provide long-term support of the vagina. Sacrocolpopexy has traditionally been performed as an open surgery, involving a 15-30 cm horizontal incision.

The UVM Medical Center now offers sacrocolpopexy using robotic-assisted surgery, a procedure which allows our surgeons to perform a minimally invasive surgery through small incisions, usually 1-2 inches.

Benefits of Robotic-Assisted Sacrocolpopexy

For most women, robotic-assisted sacrocolpopexy offers numerous potential benefits over a traditional open approach:

• Significantly less pain
• Less blood loss and need for transfusions
• Less risk of infection
• Less scarring
• Shorter hospital stay
• Shorter recovery time
• Quicker return to normal activities