uterine and pelvic organ prolapse what treatment for 92 year old

What is the treatment for pelvic organ prolapse?

Treatment of pelvic organ prolapse. The pessary is inserted into the vagina to help support the prolapsed organs. It is usually fitted to you, and it's removable. Surgery is an option for women who aren't comfortable with the idea of using a pessary, or who have tried it and found it didn't relieve their symptoms.

What can I do about a prolapsed womb?

For women with a prolapsed womb who have been through the menopause or do not wish to have any more children, a doctor may recommend surgery to remove the womb (hysterectomy). It can help to relieve pressure on the walls of the vagina and reduce the chance of a prolapse returning.

What are the best exercises for uterine prolapse?

Kegel exercises. Kegel exercises strengthen your pelvic floor muscles. A strong pelvic floor provides better support for your pelvic organs, prevents prolapse from worsening and relieves symptoms associated with uterine prolapse.

What are the different types of surgery for uterine prolapse?

There are several different types of surgery, based on the location and severity of the prolapse and other health issues. For women who have uterine prolapse, often a hysterectomy (removing the uterus) is recommended.

Can pelvic organ prolapse be treated without surgery?

The two non-surgical options for prolapse are pelvic floor muscle training (PFMT) and a vaginal pessary. PFMT can be effective for mild prolapse but is usually not successful for moderate and advanced prolapse. The main alternative to surgery for prolapse is a vaginal pessary.

What is the best treatment for uterine prolapse?

Key points for uterine prolapse Treatment for uterine prolapse includes lifestyle changes, a pessary, or surgery to remove the uterus. You may be able to prevent this condition with weight loss, a high fiber diet, not smoking, and doing Kegel exercises.

How do you treat uterus prolapse without surgery?

You could try to:Perform Kegel exercises to strengthen pelvic muscles and support the weakened fascia.Avoid constipation by eating high-fiber foods and drinking plenty of fluids.Avoid bearing down to move your bowels.Avoid heavy lifting.Control coughing.Lose weight if you're overweight or obese.

What happens if you don't treat pelvic prolapse?

Treatment of prolapse should be based on your symptoms. In rare cases, severe prolapse can cause urinary retention (inability to empty the bladder) that progresses to kidney damage or infection.

Is a pessary better than surgery?

Conclusions. In women with POP of stage II or higher undergoing surgery, prolapse symptoms were less severe than in those who were treated with a pessary, but 72% of women who were treated with a pessary did not opt for surgery.

When should you have surgery for prolapse?

Consider surgery if the prolapse is causing pain, if you are having problems with your bladder and bowels, or if the prolapse is making it hard for you to do activities you enjoy. An organ can prolapse again after surgery. Surgery in one part of your pelvis can make a prolapse in another part worse.

Is a uterine prolapse an emergency?

A prolapse is not life threatening, but it can cause pain and discomfort. Symptoms can usually be improved with pelvic floor exercises and lifestyle changes, but sometimes medical treatment is needed.

What is a Stage 3 prolapse?

Degrees of uterine prolapse The four categories of uterine prolapse are: Stage I – the uterus is in the upper half of the vagina. Stage II – the uterus has descended nearly to the opening of the vagina. Stage III – the uterus protrudes out of the vagina. Stage IV – the uterus is completely out of the vagina.

Can you push a uterine prolapse back up?

In some cases, it's possible to ease symptoms or reverse a mild uterine prolapse by doing pelvic muscle exercises, along with other self-care measures. Prolapsed uterus doesn't always require other treatment. But in severe cases, use of a vaginal pessary can provide the necessary support.

How do I know if my prolapse is severe?

Signs and symptoms of moderate to severe uterine prolapse include:Sensation of heaviness or pulling in your pelvis.Tissue protruding from your vagina.Urinary problems, such as urine leakage (incontinence) or urine retention.Trouble having a bowel movement.More items...•

How painful is prolapse surgery?

Usually the graft is anchored to the muscles of the pelvic floor. Generally this surgery is not very painful. You may feel as if you have been 'riding on a horseback'. You will have some discomfort and pain, so please do not hesitate to take pain medication.

Will a hysterectomy fix uterine prolapse?

A hysterectomy for uterine prolapse removes the uterus that has dropped into the vagina. When the symptoms of uterine prolapse become debilitating for a woman and nonsurgical treatments and surgical options to repair the uterus are not appropriate, we recommend hysterectomy.

What is pelvic floor physical therapy?

Pelvic floor physical therapy (PFPT) is among the least invasive treatment options, and when administered by a qualified physical therapist, can lead to mild anatomic improvements in POP and associated symptoms. However, PFPT is considered most useful for women with mild to moderate POP — not severe POP.

What are the three main POP treatments?

Observation (which may include physical therapy), pessaries and surgery are the three main POP treatment options. In my estimation, 30 to 40 percent of patients who choose non-observational treatment opt for a pessary, and the remainder elect surgery.

What is the success rate of reconstructive surgery?

In general, transvaginal POP surgery is less invasive than abdominal surgery and is preferred in older patients, especially those with comorbidities, because of its shorter recovery time and reduced pain and surgical risk. Overall, transvaginal surgery has a five-year success rate of approximately 70 percent if success is defined as no subsequent significant prolapse. With a broader definition of success to include outcomes with some subsequent prolapse but no need for further intervention, five-year success rates rise to approximately 85 percent.

Can a woman with anatomic pop be depressed?

If an elderly woman has anatomic POP but lacks bothersome symptoms, the condition rarely requires treatment. Conversely, POP symptoms may cause depression and poor self-image and impair participation in social activities. Associated bladder, bowel or sexual symptoms can also take their toll. And quality of life may be impacted regardless of the stage of prolapse. Vaginal bulge causing discomfort and/or bleeding, difficulty voiding and/or defecating, recurrent urinary tract infections and POP-associated low back pain are all symptoms that may warrant treatment.

Is PFPT good for pop?

However, PFPT is considered most useful for women with mild to moderate POP — not severe POP. Pessaries are the oldest known treatment for POP, dating back 2,500 years. They act as space fillers in the vaginal canal to support the vagina and block the intrusion of prolapsing tissue.

Can pessaries be used for surgery?

Well-designed studies comparing pessaries’ efficacy to surgery are scant, however. In addition to first-line treatment, pessaries can also be an excellent bridge to surgery.

Is POP treatment different for elderly?

Treatment of POP in elderly patients is not necessarily substantially different than in the general population, but there can be special considerations, lifestyle concerns and comorbidities that factor in the treatment decision. Physicians should not base treatment decisions solely on chronological age.

Can you have pop surgery safely?

In the future, we will be facing a growing number of elderly women seeking care for POP. In our retrospective analysis, we were able to show that POP surgery could be performed safely. We therefore consider surgical treatment as a valuable alternative if pessary use is not an option.

Is pessary surgery an alternative to surgery?

Pessary use is an alternative, but there are specific problems or patients may not want it. We therefore conducted a retrospective study on surgical treatment of elderly women with respect to the type of surgery and intra- and postoperative complications.

How long does anterior wall prolapse repair take?

Carey and colleagues compared symptomatic anterior wall prolapse repair outcomes at a 21 month average (12 month minimum) follow-up between 31 patients aged 80 years or more compared to 234 younger patients. They demonstrated similar rates of symptomatic failure between the groups, 6% versus 5% respectively. Recurrence of any vaginal support defect in the older group was 10%.15

How many surgeries are performed for urinary incontinence?

Over 200,000 inpatient and outpatient surgeries are performed yearly for the treatment of urinary incontinence (UI) and pelvic organ prolapse (POP) in women.2The demand for care of pelvic floor disorders has been projected to increase significantly in the coming years.

What is USS in urology?

The USS is an intraperitoneal technique that attaches the vaginal vault to the uterosacral ligaments near the ischial spine bilaterally. A culdoplasty may be performed at the same time. Published anatomic cure rates range from 65% to 98% depending on the definition of cure and the length of follow-up in an unselected patient population.22Vetere and colleagues report on outcomes of prolapse surgery in women aged 65 and older (mean 75 years), the majority receiving McCall’s culdoplasty (a variation of the USS). Twelve-month follow-up demonstrated 6% prolapse recurrence.17Intraoperative cystoscopy is recommended to verify ureteral patency due to the proximity of the ureter to the uterosacral ligament.

What are the risk factors for increased periop complications?

Risk factors for increased periop complications were length of surgery, CAD and PVD

What is the most effective technique to repair posterior defects?

The most efficacious technique to repair posterior defects is the traditional midline colporrhaphy.20Perine orrhaphy should be performed when there is separation of the perineal muscles. The posterior rectovaginal connective tissue should be reattached to the perineal body if separated. However, careful attention should be paid to avoid excessive vaginal narrowing (unless desired) as postoperative dyspareunia is a common complication. Anatomic success is high with this procedure, however functional success rates may be considerably lower regardless of age.

What is the surgical technique for anterior wall defect repair?

Surgical techniques to address anterior defects are the anterior colporrhaphy and paravaginal repair . Unfortunately, repair of the anterior wall is associated with the highest long-term failure rates of all the vaginal wall defect repairs (37% to 100% success depending on the definition and follow-up period).18Biologic graft augmentation has not been shown to improve long-term outcomes.19The efficacy and safety of vaginally placed synthetic grafts have yet to be addressed in long-term studies.

What is the lifetime risk of having surgery for UI?

The lifetime risk of having surgery for either POP or UI up to the age of 80 years is 11.1%.3Women who have undergone a procedure for UI or POP are at risk for recurrence. Clark and colleagues showed that women who underwent primary surgery for POP or UI had a 12% re-operation rate, whereas women who had had previous pelvic floor surgery experienced a re-operation rate of 17% over a 5 year follow-up period.4

What is the best treatment for pelvic organ prolapse?

Examples include: Estrogen therapy: This treatment is most commonly recommended for the treatment of cystocele. Topical estrogen creams or pills can be used to boost estrogen levels ...

How to help pelvic organ prolapse?

Kegel exercises: Kegels are useful for all types of pelvic organ prolapse and are exercises that strengthen the muscles that control urination. (You can identify these muscles by stopping urine midstream.) Patients can do three sets of ten each day: Tighten the muscles and hold for five seconds, then relax for five seconds. With regular tightening, a woman may be able to reinforce her pelvic floor to provide support for prolapsed organs.

How to treat prolapsed vagina?

Many women with mild cases of prolapse (sometimes associated with a condition called Relaxed Vaginal Outlet) can relieve their symptoms with easy-to-do exercises and a few lifestyle changes. These include: 1 Kegel exercises: Kegels are useful for all types of pelvic organ prolapse and are exercises that strengthen the muscles that control urination. (You can identify these muscles by stopping urine midstream.) Patients can do three sets of ten each day: Tighten the muscles and hold for five seconds, then relax for five seconds. With regular tightening, a woman may be able to reinforce her pelvic floor to provide support for prolapsed organs. 2 Weight loss: If a woman is overweight, losing some of the weight mass may decrease pressure on her pelvic floor and improve her symptoms. This lifestyle change is helpful for mild rectocele, enterocele, and uterine prolapse. 3 High-fiber diet: Eating a diet high in fiber can reduce constipation, a problem that can weaken the muscles of the pelvic floor. Such dietary alterations are proposed for mild rectocele, enterocele, and uterine prolapse. 4 Avoid heavy lifting: Heavy lifting can strain and weaken the pelvic floor muscles.

What is the difference between colpocleisis and da Vinci?

Typically, colpocleisis is only used in elderly patients that are no longer sexually active. da Vinci Sacrocolpopexy: This surgery uses a da Vinci robotic surgical system to do a mesh repair.

What are the symptoms of pelvic prolapse?

The most common symptom of pelvic prolapse is constipation, but others include painful intercourse, bleeding from the vagina, incontinence, pelvic pressure, and pain in the groin or lower back. If symptoms are severe, or if prolapse interferes with the urinary or reproductive systems, surgery may be needed to correct the problem.

What is pelvic floor prolapse?

Pelvic organ prolapse (pelvic floor prolapse) occurs when these muscles and ligaments are weak or damaged, causing the pelvic organs to shift and slip below their normal positions. Although pelvic organ prolapse is defined as a shift in any pelvic organ, the type of prolapse is identified by the organ that has dropped.

How to reduce constipation in the pelvic floor?

High-fiber diet: Eating a diet high in fiber can reduce constipation, a problem that can weaken the muscles of the pelvic floor. Such dietary alterations are proposed for mild rectocele, enterocele, and uterine prolapse. Avoid heavy lifting: Heavy lifting can strain and weaken the pelvic floor muscles.

How to help uterine prolapse?

Depending on the severity of your uterine prolapse, self-care measures may provide relief. You could try to: Perform Kegel exercises to strengthen pelvic muscles and support the weakened fascia. Avoid constipation by eating high-fiber foods and drinking plenty of fluids. Avoid bearing down to move your bowels.

What is the best way to repair a prolapsed uterus?

Your doctor might recommend surgery to repair uterine prolapse. Minimally invasive (laparoscopic) or vaginal surgery might be an option.

How does Kegel help with prolapse?

Kegel exercises strengthen your pelvic floor muscles. A strong pelvic floor provides better support for your pelvic organs, prevents prolapse from worsening and relieves symptoms associated with uterine prolapse.

What is the procedure for a pelvic exam?

While simultaneously pressing down on your abdomen, he or she can examine your uterus, ovaries and other organs. A diagnosis of uterine prolapse generally occurs during a pelvic exam. During the pelvic exam your doctor is likely to ask you:

What is a pessary?

Pessaries come in many shapes and sizes. The device fits into your vagina and provides support to vaginal tissues displaced by pelvic organ prolapse. Your doctor can fit you for a pessary and help you decide which type would best suit your needs. Treatment depends on the severity of uterine prolapse.

What is the purpose of a pessary?

Self-care measures include performing Kegel exercises to strengthen your pelvic muscles, losing weight and treating constipation. Pessary. A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bulging tissues. A pessary must be removed regularly for cleaning.

How to perform Kegel exercises?

To perform Kegel exercises: Tighten (contract) your pelvic floor muscles as though you were trying to prevent passing gas. Hold the contraction for five seconds, and then relax for five seconds. If this is too difficult, start by holding for two seconds and relaxing for three seconds.

What type of surgery is needed for uterine prolapse?

For women who have uterine prolapse, often a hysterectomy (removing the uterus) is recommended.

How to help prolapse?

A physical therapist can use techniques like biofeedback to help you find the right muscles to squeeze. Physical therapy with Kegels may be enough to relieve prolapse symptoms. Your doctor might also recommend a device called a pessary. Pessaries are made from silicone and come in many different shapes.

What is the most common form of prolapse?

Cystocele is when the bladder protrudes into the vagina, creating a bulge. It's the most common form of prolapse. Rectocele is when the rectum bulges into the back wall of the vagina. Uterine prolapse involves the uterus dropping into the vagina.

What is pelvic prolapse?

Image: Thinkstock. In pelvic organ prolapse, the pelvic floor. muscles weaken, causing one or more of the. pelvic organs to fall downward into or out of. the vagina.

What is the procedure for repositioning pelvic organs?

Women who are at high risk for repeated prolapse may have a procedure called sacrocolpopexy, in which the surgeon works through small incisions in the abdomen to reposition the pelvic organs back where they should be.

How to treat a swollen pelvic floor?

The first treatment your doctor might recommend is pelvic floor physical therapy, which may include Kegel exercises. You squeeze and release the muscles you use to hold in gas, which strengthens the muscles that help to support the pelvic organs.

Why does a baby's pelvic organ prolapse?

Most of the time, pelvic organ prolapse is the result of carrying— and vaginally delivering—children, which weakens the pelvic floor. "The baby's head going through the vaginal canal stretches out the connective tissues," says Dr. May Wakamatsu, assistant professor at Harvard Medical School and division director of Female Pelvic Medicine and Reconstructive Surgery at Massachusetts General Hospital.

How long does an 80 year old woman live?

Life expectancy of an 80-year-old woman has risen from 7.84 years in 1980 to 8.12 years in 2000. Normal physiological changes in the lower urinary tract of elderly women make them more susceptible to the development of prolapse and incontinence.

Is pelvic organ prolapse a problem?

Pelvic organ prolapse is a major problem among elderly women. There is a lifetime risk of 11.1% for women over 80 years of age to be operated at least one time ( 7 ). Presumably, only a small group of women who suffer from a prolapse will be operated.

Is colpocleisis justified?

In our view, colpocleisis is only justified for women whose general condition is poor and their life expectancy is short. We can conclude that the operative correction of pelvic organ prolapse in women over 80 years of age is in majority successful with an acceptable morbidity and a high satisfaction rate.

What to do if pelvic organ prolapses?

Surgery. If non-surgical options have not worked or the prolapse is more severe, surgery may be an option. There are several different surgical treatments for pelvic organ prolapse. Your doctor will discuss the benefits and risks of different treatments, and you'll decide together which is best for you.

How to stop a prolapse?

Lifestyle changes. If you do not have any symptoms or the prolapse is mild, making some lifestyle changes may help and could stop the prolapse getting worse. They can also help reduce your risk of getting a prolapse in the first place.

What is a vaginal pessary?

They can be used to ease the symptoms of moderate or severe prolapses and are a good option if you cannot or would prefer not to have surgery. Vaginal pessaries come in different shapes and sizes depending on your need. The most common is called a ring pessary.

What to do if you have a prolapsed womb?

It can help to relieve pressure on the walls of the vagina and reduce the chance of a prolapse returning.

Why do doctors delay surgery?

If you'd like to have children in the future, your doctors may suggest delaying surgery because pregnancy can cause the prolapse to happen again.

What is the best treatment for menopause?

Hormone (oestrogen) treatment. If you have a mild prolapse and have been through the menopause, your doctor may recommend treatment with oestrogen to ease some of your symptoms, such as vaginal dryness or discomfort during sex. Oestrogen is available as: a cream you apply to your vagina.

How long do you have to stay in hospital after a prolapse?

Recovering from surgery. You'll probably need to stay in hospital overnight or for a few days following prolapse surgery. You may have a drip in your arm to provide fluids, and a thin plastic tube (urinary catheter) to drain pee from your bladder.

Degree of Bother by Symptoms Is A Key Factor

Natural Progression of Pop Is Unclear

Nonsurgical Management

Surgical Management

• Surgical intervention provides the best chance for definitive resolution of POP and associated symptoms. Surgical treatment is feasible and generally safe in elderly POP patients, and postoperative complication rates are less than 5 percent. Research does not indicate a higher failure rate of POP surgery in elderly patients compared with younger pa...

See more on consultqd.clevelandclinic.org