Ashley Elizabeth Graham, CRNP

The choice of treatment for pelvic organ prolapse depends on the severity of the condition. Mild to moderate prolapse may be managed by doing pelvic floor strengthening exercises, taking hormone replacement therapy, or using pessaries. Pessaries are small devices inserted into the vagina to help support the pelvic organs. Pessary fitting is a quick procedure done in a doctor's office. For severe prolapse, surgical treatment may be necessary. Pelvic organ prolapse surgery repairs the following:

• Cystocele or bladder prolapse, where the bladder sags into the vagina. The surgeon repairs a cystocele by strengthening the front wall of the vagina using stitches so that the bladder will no longer sag.
• Enterocele or small bowel prolapse, which occurs when the small bowel descends towards the vagina. To correct an enterocele, the tissues between the small bowel and the vagina are sewn together, allowing them to provide more support.
• Rectocele or posterior prolapse, which is the bulging of the front wall of the rectum into the back wall of the vagina. Surgery to repair a rectocele removes the excess stretched tissue between the rectum and vagina.
• Uterine prolapse, which occurs when the uterus slips down to the vagina. To treat a uterine prolapse, the surgeon may secure the neck of the uterus (called cervix) to a ligament in the pelvis using stitches. Another option for this type of prolapse is a vaginal hysterectomy, which is the removal of the uterus.

Each of these procedures is performed through a vaginal incision, but an enterocele repair may use the abdominal approach as an alternative. If two or more pelvic organs have prolapsed, a combination of any of these procedures may be performed during the same surgical session.

For women who no longer wish to have intercourse, an operation called colpocleisis

may be a surgical option as well. By closing the vaginal canal, colpocleisis treats pelvic organ prolapse and eliminates any risk of its recurrence.

In most instances, pelvic organ prolapse surgery only requires a hospital stay of one day. Patients may experience vaginal bleeding for the first few weeks following surgery. If this happens, patients should use sanitary pads rather than tampons, as a higher risk of infection is associated with the use of tampons. To further help with recovery, patients should begin doing gentle pelvic floor strengthening exercises a few days after surgery. Doing these exercises at least three times a day as a routine tightens the pelvic floor muscles and prevents the recurrence of prolapse.

Treatments vary based on the severity of the incontinence. Mild to moderate leakage may be controlled by doing pelvic floor exercises, avoiding foods that can irritate the bladder, or taking medication. For severe incontinence, however, surgery may be necessary. The most common procedures for stress urinary incontinence are bladder suspension, artificial urinary sphincter surgery, and sling surgery.

Each of these procedures takes about an hour to an hour and a half. Patients will likely wake up with a catheter, a tube that drains urine, as swelling after surgery makes it difficult to urinate. Taking slow, short walks to keep the blood flow moving is usually encouraged within hours of the surgery. Although patients may return to work within seven to ten days after certain procedures, strenuous activities such as running and working out are not recommended for at least four to six weeks. In addition, patients should avoid lifting objects over 15 pounds for three months after any of these operations.

• The bladder, which stores urine.
• The urinary sphincters, which are muscles around the opening of the bladder that hold urine in.
• The urethra, which is the tube where urine flows out of the body.

Urodynamics tests are normally performed together as one series, but depending on patients' symptoms, only one or some of them may be necessary. The most common tests are:

• Cystometrogram, which measures the amount of urine the bladder can store and how full it is before someone has the urge to urinate. Doctors may order this test if she suspects their patient has a weak bladder.
• Pressure flow study, which measures the pressure in the bladder while urinating. This test helps locate a blockage in the bladder.
• Uroflowmetry, which measures how much and how fast urine flows out of the body. This test is usually recommended when patients have difficulty urinating or they have a slow stream.
• Urethral sphincter electromyography, which measures how strong the muscles and nerves in the bladder and sphincters are. Doctors may request this test if the problem they are experiencing is linked to muscle or nerve damage in the lower urinary tract.
• Urethral pressure profile, which measures the pressure along the urethra while the bladder is gradually filled with fluid. Low pressure could mean someone has a weak urethra, a contributing factor to urinary incontinence (loss of bladder control).

For a few hours following a urodynamics study, patients will likely feel some soreness or discomfort. It is recommended to drink at least one glass of water every half hour for two hours to relieve these symptoms. Holding a warm, moistened washcloth over the area where discomfort is felt or taking a warm bath may also help. Results for cystrometrograms and uroflowmetry are typically available immediately after the test, but results for the other tests may take a few days. When doctors have reviewed a patient's test results, he or she will discuss them with the patient, along with any treatments the patient may need.