Your pelvic floor muscles provide support for your bladder, uterus (in women) and rectum. But these tissues are vulnerable to damage. The tremendous pressures of childbirth and straining with bowel movements can damage these tissues.
Surgery can repair your prolapsed organs and reduce bladder and bowel problems, pain and feelings of pressure. Your doctor may also repair your posterior vaginal wall if you have a rectocele.
Diagnosis
Pelvic floor muscles act like a hammock to support pelvic organs like your bladder, uterus and rectum. If your pelvic floor muscles are weak or damaged, they can’t contract and relax correctly. This can lead to problems with urination, defecation and sexual intercourse (for women). Symptoms include feeling a bulge in your vagina or having trouble passing gas.
Pelvic organ prolapse is a common condition that develops when your pelvic floor muscles lose their strength and cause unsupported pelvic organs to drop into the vagina or rectum. This most often occurs in women after childbirth, hysterectomy or surgery on the bowels. Symptoms include leaking urine when laughing, coughing or sneezing, unable to control bowel movements and having difficulty passing gas.
If you’re having symptoms, your doctor will ask about your medical history and perform a physical exam. They’ll also do a pelvic floor muscle test to measure the strength of your sphincter and abdominal muscles. They may also order an imaging test to see if there’s any abnormality in your pelvis. This may include an ultrasound, magnetic resonance imaging (MRI) or a computed tomography scan.
If a surgical procedure is recommended, your doctor will explain the benefits and risks. They’ll also discuss your treatment options. Some treatments may include a pessary, which is similar to a ring that can stay in your body all day to provide support for your pelvic organs. Other treatments may include a bladder training program and a bowel management regimen to reduce urinary and fecal incontinence or constipation.
Defecating Proctogram
The pelvic floor is a layer of overlapping and criss-crossing muscles, fibrous tissue and ligaments that stretches across the bottom portion of your pelvis. It functions much like a trampoline, supporting the bladder, rectum and uterus as they bounce up and down through your life. Over time, the normal stresses of living can damage these tissues and cause them to weaken or even rupture. This is a common problem in older women. Symptoms include difficult or painful defecation, insufficient evacuation of stool, pain and pressure sensations at the anus, a feeling that you haven’t fully pooped or a feeling that something is pushing through your anus or vagina when straining.
A radiologist will perform this test, which is also called an evacuation proctogram, on a special radiolucent commode. The radiologist will inject a barium-based paste that allows your bowels to be seen on the fluoroscopic images. The radiologist will take several views of your anus, rectum and pelvic area while you are sitting on the commode and attempting to poop. The radiologist will look for signs of pelvic organ prolapse such as anal hernia, rectal prolapse, rectocele and enterocele.
The radiologist will send a report to your primary healthcare provider. Your doctor will discuss the results with you, answering any questions you might have. It’s important to understand that a diagnosis of pelvic organ prolapse doesn’t necessarily mean you will need surgery. Many people are able to manage their condition with medicines, physical therapy and a variety of other treatments, such as over-the-counter lubricants and pessaries.
Physical Exam
Your pelvic floor is a complex layer of muscles, ligaments and connective tissue that supports your bladder, uterus, vagina and rectum. During childbirth, the huge pressures of labor and the dilation of the pelvic muscles to accommodate a baby can weaken or damage your supporting structure.
As a result, your organs can prolapse downward toward the ground. Depending on which organs are affected, the prolapse may be mild or severe. Women and people assigned female at birth (AFAB) are more likely to develop a dropped bladder or rectum, but men and people assigned male at birth (AMAB) can also experience these problems.
The Doctor will start by locating your ischial spines on each side of your pelvis, which run up to the sacrum. Running from the ischial spines is a firm ligament called the sacrospinous ligament. The Doctor will use a suturing instrument to attach permanent sutures to the sacrospinous ligament on each side.
Next, the Doctor will place a surgical mesh called the Repliform Graft Matrix in a hammock-like fashion across your pelvis, placing it under your bladder and above your vaginal apex for upper vaginal support. Then the Doctor will assess your posterior vaginal wall for a rectocele, which indicates loss of support along this area. This is the type of prolapse that doesn’t improve with exercise or other treatments, and surgery might be needed.
X-Rays
The muscles that make up the pelvic floor control your bladder, bowels and uterus (in women). When these muscle weaken or break down they lose their normal support. This can lead to organ prolapse – when the pelvic organs drop below their normal position and press against your vagina or abdomen. This can cause symptoms like pain, pressure or urinary and bowel leakage.
Pelvic floor exercises like Kegels help strengthen these muscles. These exercises train these muscles to contract for longer periods of time – from two to 30 seconds, instead of the short or “fast twitch” muscle contractions that are usually used in sports and other high intensity activities. Unfortunately, most people don’t perform these exercises correctly. This can lead to only a temporary reduction in your symptoms, or even a worsening of your prolapse.
Another option is to use a surgical mesh that provides extra support to the weakened muscles. This is called a prosthetic mesh and can be placed in the abdomen or the vagina depending on your situation.
Surgery can also be done to reattach and reinforce the pelvic ligaments that form the upper part of the vaginal vault. This is called perineorrhaphy. This procedure can be performed under general or regional anesthesia and is usually done in conjunction with anterior and posterior prolapse repair. pelvic floor repair