Pelvic Organ Prolapse

Our practice is among the top five in the nation in robotic/minimally- invasive pelvic reconstructive surgery.

Our physicians lead the region in minimally invasive procedures for the treatment of pelvic organ prolapse and urinary incontinence.

Prolapse Conditions 

Bladder Prolapse

Normally a ‘hammock’ (a layer of connective tissue) between the bladder and the vagina supports the bladder. When it stretches or tears, the bladder bulges or presses into the vagina. Patients may notice vaginal pressure or pulling. If the bladder drops very low, you may have to ‘push’ the bladder back up to be able to urinate.

When the ‘hammock’ is just torn, we can sew it back together with stitches. If it is very weak and damaged, we may use a graft to replace it. Generally this surgery is not very painful, though you will have some discomfort.

Vaginal Suspension

Normally, ligaments hold the vagina up in normal position. If these ligaments stretch or break, the top of the vagina will begin to drop. Sometimes, some of the intestines are pulled down with it, called an ‘enterocele’ or ‘bowel-hernia’. You may feel a bulge in the vagina, and feel a vaginal ache.

Vaginal suspension surgery reattaches the vagina to the ligaments meant to hold the vagina up. Sometimes we have to push the intestines up and out of the way, and stitch them back in place so they don’t drop down again.

If the ligaments that hold the vagina up are very weak, we use a different ligament (the sacrospinous-ligament) near the buttock muscles to hold the vagina up instead.

Dropped Uterus

Your uterus can drop after vaginal childbirth if the normal ligaments supporting the uterus stretch or tear. A vaginal hysterectomy can be done to remove the uterus and cervix through the vagina. Once the uterus is removed, we use additional stitches to support the top of the vagina, preventing it from dropping again.

Bulging Rectum

The rectum lies underneath the vagina. Normally there is a layer/‘hammock’ (we call it ‘fascia’) between the vagina and the rectum that keeps the rectum flat. When this ‘hammock’ tears or stretches, then the rectum ‘pouches’ or ‘bulges’ into the vagina. You may notice this as a ‘bulge’ in the vagina that you see or feel when you wipe with the toilet paper. Or you may have a tough time getting the stool out during a bowel movement. You may feel as if the stool gets ‘stuck’ in the rectum. You may need to press and push with your hand to get the stool out.

Surgery attempts to restore that ‘hammock’. Sometimes if the ‘hammock’/tissue is just torn, we can sew it back together with stitches. Sometimes if the ‘hammock’/tissue is very weak and damaged, we substitute it with a graft and essentially replace your hammock.

The way we do the surgery is to make an incision (make a cut) in the lining of the vagina above the rectum. We find the torn edges of your hammock and sew them back together. We then sew the vaginal lining back together. If your ‘hammock’ is very weak and poor quality then we may place a graft between the rectum and vagina. We then sew the vaginal edges closed again so that the graft is completely covered. Usually the graft is anchored to the muscles of the pelvic floor.

Laparoscopic and Robotic Prolapse Surgery

We routinely use robotic surgery to treat uterine or bladder prolapse with a highly-effective procedure called abdominal sacral colpopexy.

The robot makes the procedure easier to perform and avoids the need for an abdominal incision. Our surgeons undertake extensive coursework and training and go through an exacting credentialing process before using this robotic system.

Patient Education