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Urogynecology (Expert Forum)
ajsgirl
Answered by
Lennox Hoyte, M.D. - UroGynecology, Pelvic Surgery
USF College College of Medicine
Tampa - FL
Questions in the Urogynecology forum are answered by medical professionals affiliated with USF Health. Topics covered include overactive bladders, bladder pain, fallen/drooping bladder, bowel urgency, bowel prolapse, cystitis, incontinence, pain with intercourse, rectal prolapse, surgery, urinary urgency, and uterine prolapse.
ajsgirl
by ajsgirl, Nov 19, 2007 01:16PM
I am a 40 yr old that had a hysterectomy about 5 yrs ago lately I have had alot of adbominal pain gas bloating and I have not been able to have a full bowel movement last week I noticed that I had a bulge in my vagina and the opening has closed severly I believe that I have a vaginal prolapse is it possible to have a vaginal prolapse and not a bladder prolapse at the same time? and would the prolapse cause my stomach problems? I have a Dr appointment next week, Do they always recommend surgery or is there alternitives that are tried first?
Doctor's Answer
by Lennox Hoyte, M.D., Nov 19, 2007 06:36PM
, Nov 19, 2007 06:36PM
Think of the vagina as a long tube. Normally the front wall of the vagina holds up the bladder, and ths back wall pushes down on the rectum. The top is usually held up by the uterus and some ligaments which connect to the tailbone near the sacrum.
Prolapse happens when any one of these walls give way or fall down and protrude throug the vaginal opening. If the front wall is falling, many docs call it a cystocele. If the back wall is falling, it is called a rectocele. If the top is falling down, it may be called an enterocele. No matter what we think is falling, the weakness is usually of the vaginal wall (front, back, or top). so the easy (and correct) way to think of this as prolapse of the front, back or ceiling of the vagina. to fix this problem, the vaginal walls need to be resuspended, in order to pull the ceiling up, together with some strengthening of the front and/or back walls of the vagina. This procedure is called a vaginal vault suspension, sometimes with something called an "Anterior (front wall)/Posterior(back wall) repair". This can usually fix the problem of prolapse. This can be done through the vagina or through an incision in the abdomen. If you are not inclined to have surgery, then you can try a pessary, which is a small rubber ring which goes inside the vagina and can help hold the vaginal walls up. PEssaries do not work for every woman. Sometimes they can fall out, especially if the vagina is narrowed by prior surgery, or if the pelvic floor muscles are weak. Most important, prolapse is usually not a life and death problem, and is certainly not an emergency. Symptoms include back pain, and discomfort from the bulge, as well as urinary frequency, and trouble emptying your bowels. Occasionally, urinary retention can be a problem which needs timely attention. Best to find a trained urogynecologist, who can help you choose the therapy that is right for you. Go to sgsonline.org, put in your zip code and they will locate a pelvic surgeon or urogynecologist member in your area who can help you.
Dr. Hoyte.
Prolapse happens when any one of these walls give way or fall down and protrude throug the vaginal opening. If the front wall is falling, many docs call it a cystocele. If the back wall is falling, it is called a rectocele. If the top is falling down, it may be called an enterocele. No matter what we think is falling, the weakness is usually of the vaginal wall (front, back, or top). so the easy (and correct) way to think of this as prolapse of the front, back or ceiling of the vagina. to fix this problem, the vaginal walls need to be resuspended, in order to pull the ceiling up, together with some strengthening of the front and/or back walls of the vagina. This procedure is called a vaginal vault suspension, sometimes with something called an "Anterior (front wall)/Posterior(back wall) repair". This can usually fix the problem of prolapse. This can be done through the vagina or through an incision in the abdomen. If you are not inclined to have surgery, then you can try a pessary, which is a small rubber ring which goes inside the vagina and can help hold the vaginal walls up. PEssaries do not work for every woman. Sometimes they can fall out, especially if the vagina is narrowed by prior surgery, or if the pelvic floor muscles are weak. Most important, prolapse is usually not a life and death problem, and is certainly not an emergency. Symptoms include back pain, and discomfort from the bulge, as well as urinary frequency, and trouble emptying your bowels. Occasionally, urinary retention can be a problem which needs timely attention. Best to find a trained urogynecologist, who can help you choose the therapy that is right for you. Go to sgsonline.org, put in your zip code and they will locate a pelvic surgeon or urogynecologist member in your area who can help you.
Dr. Hoyte.
