Advanced, Compassionate Care
The pelvic floor is the group of muscles that form a hammock or sling across the lower part of the pelvis. Along with surrounding tissues, these muscles hold the pelvic organs in place so they can function correctly. When these muscles become weak, it may lead to pelvic organ prolapse. The pelvic organs—such as the uterus, cervix, and/or bladder—may drop from their regular positions in the body and move into, and sometimes protrude from the vagina or rectum.
Pelvic floor disorders can disrupt a woman’s life by causing discomfort, difficulty emptying the bladder or rectum, and urine leakage, among other symptoms. The urologists at NewYork-Presbyterian Queens understand how these symptoms can affect your well-being. We work with our colleagues in Urogynecology to offer the latest techniques to treat pelvic floor disorders so you can start living more comfortably.
Diagnosing Pelvic Organ Prolapse
Pelvic organ prolapse is diagnosed by physical exam. The doctor assesses the front and back walls of the vagina, the top of the vagina, and the uterus. The degree of prolapse is measured when you are both lying down and standing. The physician carefully measures all aspects of pelvic floor support before suggesting a treatment plan for you.
Nonsurgical Treatments for Pelvic Organ Prolapse
Our doctors will describe options to treat your pelvic organ prolapse based on your exam results.
Kegel exercises
For mild pelvic floor disorders, Kegel exercises strengthen the pelvic floor muscles to support the organs better and slow the rate of prolapse. Kegels involve the muscles you use to stop the flow of urine midstream. Kegel exercises are also useful for controlling urinary leakage and fecal incontinence. Your doctor will tell you how many repetitions you should do each time and how many times per day to get the best benefit.
Pelvic floor therapy
Pelvic floor therapy includes visits to a physical therapist with specialized training in pelvic floor disorders. The goal is to strengthen the pelvic floor. Examples of pelvic floor therapy include:
- Biofeedback. An intravaginal device trains the pelvic floor muscles to contract and relax properly.
- Functional electrical stimulation. A device used either in the vagina or externally delivers a gentle electrical current to activate or relax the pelvic muscles and nerves.
- Manual therapy. Women with pelvic organ prolapse often subconsciously contract their pelvic floor muscles to create muscle spasms. These spasms may cause pelvic pain, painful sex, and difficulties with urination and defecation. With manual therapy, pressure is applied to and released from pelvic muscles in spasms to relax them and increase blood flow.
- Joint and tissue mobilization. This therapy involves gentle manipulation to help calm the nerves and muscles of the pelvis.
Vaginal pessary
A vaginal pessary is a removable, diaphragm-like device worn within the vagina to support the bladder or other organs that are prolapsing through the vagina. It may also be used to reduce stress incontinence. Pessaries come in a variety of types and sizes. Fitting may require two or more office visits to select the proper type and size that will work for you.
Surgery for Pelvic Floor Disorders
Surgery may be necessary when nonsurgical treatments are ineffective enough to relieve pelvic organ prolapse. Whenever possible, our surgeons use minimally invasive robotic techniques to perform these procedures, operating through small incisions so you can have less discomfort and recover more quickly.
Colporrhaphy
Anterior colporrhaphy uses a woman’s existing connective tissue to bolster support of the bladder and vagina. Posterior colporrhaphy reconstructs connective tissue to support the rectum and vagina.
Perineorrhaphy
This surgery repairs a weakened perineum (the area between the vaginal opening and the anus).
Vaginal vault suspension and uterine resuspension
The surgeon suspends the top (“apex”) of the vagina by attaching it to a ligament in the pelvis—usually either the sacrospinous ligament or the uterosacral ligament.
Hysterectomy
A hysterectomy (including vaginal, laparoscopic, or sometimes abdominal) is often performed as the first step of repairing pelvic organ prolapse. Doing so often results in better attachment of the vagina to the surrounding supportive tissues.
Graft-augmented prolapse repair
When a woman’s connective tissue is too weak to allow for successful prolapse repair, the surgeon will offer “graft augmentation” using synthetic mesh or biologic graft material. Minimally invasive surgical approaches, which include robotic and laparoscopic sacrocolpopexy, involve fashioning a custom-made Y-shaped mesh to reconstruct the entire support system of the pelvic organs through attachment to a ligament near the backbone. Graft material may also be used to strengthen procedures which use a patient’s own tissue.
Surgery for Pelvic Floor Disorders
Pelvic organ prolapse is quite common for several reasons, including pregnancy, vaginal birth, and menopause. Whatever the cause of your discomfort, the doctors at NewYork-Presbyterian can match you with the treatments to relieve your symptoms and improve your quality of life. Since we are part of NewYork-Presbyterian, one of the country’s largest medical centers, you’ll also have access to specialists from all areas available to provide comprehensive care. Give us a call today and make an appointment.