Monday, August 29, 2011

Ask Us Anything: What are the Symptoms and Causes of Pelvic Prolapse?

"I am in my late 20s and believe that I am experiencing the symptoms of pelvic prolapse: painful intercouse, urine leakage and frequent urinary tract infections.

I have always experienced these symptoms, so until I read a description of pelvic prolapse, I thought that they were a normal part of life.

How is pelvic prolapse diagnosed? I've had pap smears, but my physician has never mentioned anything being out of the ordinary.

Are there any other probable causes?

And what are the treatment options? I've read that surgery is a possibility but that it is not a solution for those planning to have children. I haven't started a family yet but plan to in the future."

Doctors Scott Zuccala, Ali Ghomi and Samuel Saleeb Respond:

Dr. Zuccala: Pelvic prolapse, urinary complaints (such as frequent UTI's, leakage of urine, pain with urination), and other associated symptoms such as painful intercourse, can be part of issues with prolapse or they can be different disease processes.

Dr. Ghomi: Pelvic organ prolapse commonly affects women after the fifth decade of life.The risk factors are having had multiple deliveries, hysterectomy and genetic predisposition.

Dr. Zuccala: Prolapse in a young person such as yourself is rare. It is usually, but not always, associated with childbirth. It is most often a process that takes years to develop.

Dr. Ghomi: However, certain connective tissue disorders and neurologic conditions such as spina bifida can cause pelvic prolapse to occur at a young age.

Dr. Saleeb: Vaginal prolapse in young patients may also be due to genetic reasons (someone in the family would have had this condition). A person with vaginal prolapse would feel vaginal pressure, discomfort and heaviness, which increases by the end of the day.

Dr. Ghomi: Urinary incontinence may be present in someone who is experiencing pelvic prolapse, especially cystocele or dropped bladder, but not always.

Dr. Saleeb: One of the common causes of urinary incontinence is bladder infection. Also, interstitial cystitis (a condition that cause painful bladder and urinary incontinence) is common in young patients.

Dr. Zuccala: Treatment of pelvic prolapse may be surgical, but we also offer patient-centered measures, such as keigel exercises, that involve tightening of the pelvic floor by squeezing the vaginal muscles. We can use a pessary, a device that holds up the pelvic floor. But, this is used more in the elderly. Surgery is usually reserved when those measures fail or when they are not appropriate.

Dr. Saleeb: For patients with mild prolapse who want to preserve fertility, we can use a treatment of electrical stimulation and pelvic floor physical therapy.

Dr. Ghomi: Or, uterine-sparing pelvic reconstructive surgical procedures may be performed.

Dr. Zuccala: In your case, I would do a thorough exam, including a detailed neurologic and pelvic exam. I may include a cystoscopy to assess your bladder and urethra. And also a review of any medication, over-the-counter or otherwise that you may be using. We would need to establish a diagnosis before looking at treatment options.

About Our Physicians

Dr. Zuccala

Dr. Zuccala is a gynecologic surgeon at Mercy Hospital of Buffalo.
He practices obstetrics and gynecology, including minimally invasive surgery, and vaginal and pelvic reconstruction for prolapse and urologic incontinence surgery.
He was one of the first surgeons in the Buffalo area to perform minimally invasive gynecological surgery for non-cancerous conditions using the da Vinci® Robotic Surgical System.

Dr. Ghomi

Dr. Ghomi is the Director of Minimally Invasive Gynecologic Surgery and Chair of The Robotic Surgical Committee at Sisters of Charity Hospital.
He is the only physician in Western New York who performs Sacrocolpopexy Prolapse surgery using the da Vinci® robot. Sacrocolpopexy is a proven “gold standard” procedure worldwide to repair severe pelvic prolapse.

Dr. Saleeb

Dr. Saleeb is a urogynecologist, which is a gynecologist who specializes in the care of women with pelvic floor dysfunction. He practices at the Saleeb Uro-Gynecology Center in Williamsville. He also practices twice monthly at the Ken-Ton FamilyCare Center in Tonawanda (a full evaluation of the pelvic floor is not available at this location).

He provides evaluation and management of pelvic floor disorders and offers clinical exams, urodynamic testing, cystoscopy, pelvic floor physical therapy, and behavioral therapy. He also manages a program for the prevention of pelvic floor disorders in women. At his research center, Dr. Saleeb is currently involved in three different studies.

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