Clinician-to-Clinician Update Clinician-to-Clinician Update

Improving Quality of Life for Women with Pelvic Organ Prolapse

May 2016

Pelvic organ prolapse, appearing with or without symptoms, is extremely common. Over 40 percent of postmenopausal women older than 60 years who have not had a hysterectomy are estimated to have the condition.1 Defined as the descent or herniation of pelvic organs from their normal position or attachment sites, the condition involves the uterus, vaginal apex, anterior vagina, or posterior vagina among other pelvic structures.

The etiology of the condition can be complex. Pregnancy itself, even without vaginal birth, is a known risk factor, although the exact mechanisms are not completely understood. Vaginal childbirth is another well-documented risk factor, as it can stretch and tear the endopelvic fascia and the levator muscles and perineal body.2 Other contributing factors include conditions that increase intra-abdominal pressure, such as obesity, chronic pulmonary disease, and constipation.3

Although many women may have some degree of prolapse upon examination, most do not require any treatment other than reassurance.4 Prolapse, however, can be associated with symptoms such as discomfort, sexual dysfunction, urinary frequency/urgency, urinary tract infections, and emotional distress.5, 6 Symptoms, however, may not be proportional to the degree of prolapse. A patient with a smaller degree of prolapse may experience a range of symptoms while another with a higher degree of prolapse has minimal symptoms.

A cross-sectional analysis of 1,961 nonpregnant women aged 20 years and older who participated in the 2005–2006 National Health and Nutrition Examination Survey, a nationally representative survey of the U.S. noninstitutionalized population, found the overall incidence of symptomatic pelvic organ prolapse to be 2.9%.7 The incidence increased with patient age, from 1.6% among women aged 20 to 39 years, to 4.1% among women aged 80 years and older.

Decisions on treatment for symptomatic prolapse relate to the severity of symptoms, the organs involved, presence of other medical conditions, and individual quality-oflife factors. Nonsurgical treatment options include use of a pessary and physical therapy. A variety of surgical approaches are also available, including open surgeries as well as laparoscopic and robot-assisted approaches. (See Case Study for a discussion of a robot-assisted surgical approach.)

University of Minnesota Health physicians research urologic conditions affecting women and study the efficacy of available treatments. Our multidisciplinary team of experts provides patients with pelvic organ prolapse a comprehensive treatment plan tailored to each individual. Treatment plans include nonsurgical and surgical treatment options, as appropriate, to ensure best possible outcomes.

References

  1. Hendrix SL, et al. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186:1160-1166.
  2. Handa VL, et al. Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth. Obstet Gynecol. 2011;118:777-784.
  3. Kuncharapu I, et al. Pelvic organ prolapse. Am Fam Physician. 2010;81:1111-1117.
  4. Slieker-ten Hove MC, et al. Prediction model and prognostic index to estimate clinically relevant pelvic organ prolapse in a general female population. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:1013-1021.
  5. Thibault F, et al. Impact of laparoscopic sacrocolpopexy on symptoms, health-related quality of life and sexuality: a medium-term analysis. BJU Int. 2013;112:1143-1149.
  6. Dunivan GC, et al. Pelvic organ prolapse: a disease of silence and shame. Female Pelvic Med Reconstr Surg. 2014;20:322-327.
  7. Nygaard I, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300:1311-1316.

When to refer

University of Minnesota Health urologists are happy to see all patients with urology-related conditions, including those with concerns about a bulge in or outside the vagina. Symptomatic patients with urinary frequency or urgency, urinary tract infections, sexual dysfunction, difficulty with physical activity, or discomfort should be referred promptly to explore nonsurgical and surgical treatment options.

Our urology team is highly skilled in the management of symptomatic pelvic organ prolapse. We offer nonsurgical treatment options, such as physical therapy, as well as a variety of surgical techniques, including vaginal, abdominal, laparoscopic, and robot-assisted approaches. Surgical options include:

  • Anterior and posterior colporrhaphy
  • Le Fort or modified Le Fort colpocleisis
  • Sacrocolpopexy
  • Sacrohysteropexy
  • Sacrospinous fixation
  • Uterosacral ligament suspension

We treat patients with pelvic organ prolapse at 2 Minneapolis locations and at our Maple Grove Clinics. In addition to these locations, we provide other urology care and services at clinics in Edina and Wyoming, Minnesota. Learn more here.

Collaborative Care

The University of Minnesota Health urology team has a high-level of expertise in diagnosing and treating common and rare female urologic disorders, including incontinence and pelvic floor disorders. We take a multidisciplinary, comprehensive approach to providing urologic care. We offer specialized diagnostics, such as urodynamics; nonsurgical treatment, including physical therapy; as well as surgical interventions, including robotic surgery and sacral nerve modulation. We understand that referring providers often have longstanding relationships with patients, and we consider the referring provider to be a critical part of the care team. We are committed to providing prompt communication and will contact referring providers usually within 72 hours after a patient is seen in one of our locations.

Find current clinical trials available through M Health providers here.

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