Pelvic area herniation and bulging of vaginal tissues is often due to a condition termed pelvic organ prolapse, which affects 50% of women at some point in their lives. When this occurs, your pelvic organs may feel as though they are about to fall out of your body. It is important to understand that many of these problems may be treated successfully.
The normal vagina and surrounding organs, the bladder and rectum, depend on the supportive tissue to maintain their usual anatomic position. This supportive tissue may be damaged during life events such as childbirth, but genetics or family history also play an important role in determining if you are prone to develop this issue.
Treatment may involve a variety of modalities. Pelvic floor muscles comprise some of the connective tissue which makes up the lower tissue which is responsible for supporting the organs of the pelvis and abdomen. Exercising these muscles may help to keep them strong and maintain or improve the position of the pelvic floor. Some refer to these exercises as Kegel exercises and describe them as squeezing the vaginal walls together repetitively to improve the muscle strength. These are the same muscles as those used when you must urgently attempt to stop the flow of urine during voiding. Physical therapy specialists are sometimes used to facilitate this process as well.
Another non-surgical treatment involves the use of a device which is termed a “pessary”. Pessaries are available in many shapes and sizes and are fitted to your body during an office visit. The pessary helps to support the vaginal walls back to its normal position and can remain in place for days, weeks or even months. Simple removal may be performed by the patient or her partner, or by returning to the clinic for removal. Once removed, the device is cleaned with soap and water and then may be replaced back into the vagina.
A variety of surgical options may be used to treat prolapse and these are chosen by 11% of women with prolapse. Minimally invasive procedures can be performed with only small incisions and often the patient may return home the same day as surgery. Surgery performed on or through the vagina may be suggested to repair some of these hernias over the bowel and bladder, or to position a sling support under the bladder neck (urethra) to treat stress urinary incontinence. Ligaments supporting the top of the vagina may be reattached and shortened to resuspend the vaginal apex back into position.
The gold standard surgical procedure for prolapse is laparoscopic, robotic or open access to the pelvis to dissect out the front and back walls of the vaginal, then sew a sturdy mesh onto these vaginal walls; the opposite end of the mesh is then sewn to the sacral promontory. This procedure is termed a sacrocolpopexy and has been performed for more than 60 years as an open procedure, but recently (15+ years) is offered as a laparoscopic or robotic minimally invasive procedure by Dr Richey.