Uterine or Vaginal Vault Prolapse

A weakening of the pelvic floor muscles and tissues that support the pelvic region causes pelvic floor disorders. The pelvis has a "hammock" or "sling" of muscles, located in the lower abdomen, that stretch across your pelvic floor. For both men and women, the pelvic floor supports the bladder, bowel, rectum and urethra and maintains urinary and fecal continence. In women, these are the muscles that support the uterus and play an important role in vaginal childbirth. Over time they may become stretched or weakened.

Women with pelvic organ prolapse typically have problems with urinary incontinence, vaginal ulceration, sexual dysfunction and/or having bowel movements. Symptoms of a pelvic floor disorder can be minor to major, depending on the position of the organs, and may include a feeling of pressure in the vagina, pain in the abdomen or pain during sex. Urinary troubles are also common such as urge or stress incontinence and/or a feeling of not being able to completely empty the bladder. In addition, prolapse can contribute to bowel problems including constipation, incomplete emptying or fecal incontinence.

For those with severe prolapse, the uterus, bladder or rectum may descend or bulge into the vagina, sometimes to where they can actually be seen protruding from the vaginal opening.

When the muscles or ligaments that support the pelvic organs break or weaken, the condition is called pelvic organ prolapse, which can also result from pelvic injury associated with the abdominal pressure of coughing, heavy lifting, constipation, pelvic surgery, neurological injury, obesity, menopause and hormonal deprivation or medications. Anatomical abnormalities are another cause for women experiencing these same functional symptoms.

Minimally Invasive and Robotic Treatments 

Laparoscopic pelvic floor repair is a surgical option for prolapse. In this procedure, surgeons insert a tiny telescope (laparoscope) through a small incision. The laparoscope is attached to a camera-television setup, giving the surgeons a magnified view of the pelvic floor. After making several "keyhole" incisions in the abdomen, the surgeons use specially designed instruments to lift and attach the prolapsed organs back in their normal positions with permanent sutures. 

Robotic sacrocolpopexy can be used to correct vaginal prolapse (when the top of the vagina loses support and drops through the vaginal opening). During the procedure, a piece of mesh is attached to the top of the vagina and the other end is attached to the sacral promontory that is located at the back of the pelvic floor and lower part of the spine. Surgeons use specially designed instruments to lift the prolapsed organs back to their correct anatomical position and attach them with permanent sutures.

By using the da Vinci robot, surgeons are able to perform the procedure through several small incisions instead of a large single incision. That can result in:

  • Shorter hospital stays
  • Less pain
  • Less blood loss and less need for transfusions
  • Less scarring

The GW Pelvic Floor Center offers both diagnosis and treatment of pelvic organ prolapse including minimally invasive and robotic surgery to restore the anatomy of the vagina and structural support to their normal states.