Pelvic Floor Prolapse

A pelvic floor prolapse does not necessarily require surgery.  Highly effective and safe non-surgical treatment modalities are available.  In terms of lifestyle alterations, it might help to stop lifting heavy items, start consuming foods that are high in fiber and lose weight if you are obese or borderline obese. However, if such alternative treatments do not work and your prolapse is not controlled, surgery will be considered. 

Put your faith in our doctor, Arathi Veeraswamy, MD, and we will steer you in the right direction.  As an example, we might recommend non-surgical treatment in the form of alterations to your lifestyle, a vaginal support device and/or pelvic floor physical therapy.  The use of a pessary to push back against the prolapse for relief might also be recommended.  The approach dubbed “watch for now” is an approach characterized by refraining from treatment and observing how the condition progresses or regresses moving forward.  However, watch for now is typically restricted to patients who are not experiencing interference with daily living and discomfort. 

If necessary, we will advise POP surgery.  The type of POP surgery optimal for you hinges on the severity of your systems, your health, your age and your preference.  Vaginal mesh surgery will be considered if there is no other alternative and you need immediate relief.  This procedure involves the addition of synthetic mesh to keep the pelvic organs in position.  Meet with our doctors and we will go over the pros and cons of each option including their unique risks. 

Uterine Prolapse

Uterine prolapse is treated at our Reno, NV office with both non-surgical and surgical options. Our medical professionals, Arathi Veeraswamy, MD and Brooke Maclennan, CNM are here to help you choose the best option in the aftermath of your uterine prolapse. Your health, age, prolapse severity and desire for children shape the approach. We will likely suggest non-surgical options to start out. As an example, Kegel exercises help to increase the strength of the pelvic floor muscles. A vaginal pessary consisting of plastic device shaped like a donut that is positioned below the bottom of the uterus might also help prop it upward and stay in position.

Medications including estrogen cream can be inserted to the vagina to improve its strength and bolster the vitality of the vagina’s tissues. However, if necessary, we will consider surgical options such as a hysterectomy and repair of the prolapse. This procedure involves the removal of the uterus through the abdomen. This is a major surgery that prevents pregnancy.

It is also possible to perform prolapse repair without a hysterectomy. Such a procedure moves the uterus back to its regular position. A uterine suspension is performed with a reattaching of the pelvic ligaments to the uterus bottom to secure it in place. This surgery is performed through the abdomen or vagina.

Cystocele

Reno Tahoe Women’s Health is here to help with your cystocele. If you notice any indications of cystocele, reach out to us at (775) 210-0885 for assistance. We will help you enhance the strength of your pelvic floor with targeted exercises including Kegels. The pelvic floor primarily consists of muscles so it is sensible to exercise to bolster support for the pelvis. You might also obtain considerable benefit from hormone therapy that boosts resources to support tissues including ligaments and muscles. The heightening of hormone levels moves resources to connective tissues necessary for supporting pelvic organs.

If your cystocele is severe or moderate, your quality of life will diminish. Our team is here to gauge the degree of the bladder prolapse through a thorough symptom review. We use special testing along with advanced imaging as well as urodynamics to measure muscle functionality and nerve functionality to understand the cystocele stage. It is at this point that we develop the optimal treatment plan to return your quality of life back to normal or as close to normal as possible. Estrogen therapy with the use of a pessary ring in the vagina might help improve bladder functionality. However, surgery will be considered if a pessary does not resolve the cystocele.

Rectocele

Rectocele is treatable. If your rectocele case is mild, our medical professionals Arathi Veeraswamy, MD and Brooke Maclennan, CNM, might recommend pelvic floor exercises and/or bowel training. If you have a moderate or severe rectocele case, you will likely be treated with a support device added to the vagina called a vaginal pessary. However, there is also the option of a minimally invasive surgical procedure referred to as rectocele repair. Rectocele repair is recommended if other treatment methods do not work as planned.

If your symptoms do not improve, rectocele repair will bolster the strength of the wall between the rectum and vagina. This surgical procedure requires an incision within the anterior wall of the vagina. The wall’s layers are connected with suturing to enhance tissue tightness and strength. However, the specific treatment for your rectocele will ultimately hinge on the severity of the prolapse. It is possible the doctor will start out by recommending observation and self-care. Report your progression or regression to our office and we will move forward with additional treatment modalities if necessary.

Urinary Incontinence

The treatment for urinary incontinence depends on a wide range of factors. Schedule an appointment with our office in Reno, NV by dialing (775) 210-0885 and we will slot you in for an appointment. Our medical professionals will analyze your unique type of incontinence, mind state, general health, age and other factors. We might recommend pelvic floor exercises that bolster the strength in your pelvic floor and sphincter muscles to help you better control your urination.

Bladder training might also help. This training delays the release of urine so you can better control your urges to relieve yourself. Establishing a toilet timetable in which you use the bathroom at specific times of the day such as every couple hours might help mitigate or eliminate urinary incontinence. Even double voiding in which you urinate, wait a few minutes and urinate once again might help alleviate urinary incontinence.

The aim of such training is to help you regain control over your bladder. However, if training does not work, we will consider medications used alone or in combination with exercises and/or techniques. As an example, estrogen has the potential to reinforce the vaginal and urethra tissues to reduce symptoms. Anticholinergics help to calm an overactive bladder, ultimately reducing urge incontinence.

If medications do not work, we will consider radiofrequency therapy in which the urinary tract tissue is heated to improve urinary control. A pessary ring can also be added to the vagina to elevate the bladder and minimize or even eliminate leakage. A urethral insert can be added prior to activity to provide additional support, then subsequently removed at the time of urination.

Non-Surgical Options

Pelvic floor Exercises

Reno Tahoe Women's Health recommends pelvic floor exercises for individuals looking to strengthen he muscles around the vagina, bladder and other body sites. Those saddled by urinary incontinence or pelvic organ prolapse obtain considerable benefit from pelvic floor exercises. These exercises are relatively simple as they typically require that the patient simply sit still and squeeze the muscles in question 10 to 15 times. Our doctor will provide advice in regard to technique and tips. As an example, it is not in your interest to tighten your stomach or hold your breath during pelvic floor exercises.

Continue to implement more squeezes as time progresses, give yourself ample time to rest between those squeezes and you’ll eventually enjoy meaningful results. However, once your pelvic floor exercises start to work, it is not an opportunity to declare victory and halt the exercises. Rather, this accomplishment should be viewed as minor progress. Continue the exercises across a period of months, resist the temptation to stop after you make progress and you’ll successfully strengthen your pelvic floor muscles.

Vaginal Hormonal Therapy

The transition to menopause will slow the production of estrogen and progesterone in the ovaries. Alterations in hormone levels lead to discomfort. As an example, our Reno, NV medical professionals Arathi Veeraswamy, MD and Brooke Maclennan, CNM, often notice patients who reach menopause experience vaginal dryness, hot flashes, urinary urgency, mood swings, insomnia and night sweats.

Hormone therapy, often referred to as HT, helps to improve hormone levels and relieve menopause symptoms. Hormone therapy is available in the form of estrogen therapy in which a patient is provided with an estrogen dose in the form of a patch or pill for daily use. Some forms of estrogen are available as sprays, gels, vaginal rings or cream.

Estrogen progesterone hormone therapy, commonly referred to as EPT, combines progesterone and estrogen to reduce monthly bleeding. However, if you do not have your uterus due to a hysterectomy, you won’t have to take progesterone. The use of estrogen by itself poses less of a risk across posterity than hormone therapy. However, most patients experiencing menopausal symptoms obtain consider relief through hormone therapy.

Pessary Fitting

Pessary fittings, also referred to as pessaries, are available through our Reno, NV office. This fitting consists of a silicone ring positioned within the vagina to provide support to tissues compromised by pelvic organ prolapse. Several types of pessaries are available. As an example, patients with especially severe cases are provided with cube pessaries that are compacted and subsequently inserted into the vagina that uses suction for the support of tissues caused by prolapse.

Gellhorn pessaries are discs with diminutive knob-like shapes also used for severe cases. Gehrung pessaries are shaped like the letter “u” and built specifically for each individual patient who endures a significant uterine prolapse. Ring-shapes pessary fittings are the most common variety. This type of pessary is comparably simple and can be used without considerable guidance from a medical professional.

Whether you are concerned you have suffered a pelvic organ prolapse or know you have, it is in your interest to meet with our medical team to determine if you can benefit from a pessary fitting. Reach out to us today at (775) 210-0885 to schedule an appointment.

Surgical Options

Vaginal Hysterectomy

A vaginal hysterectomy is a procedure performed to remove a patient’s uterus by way of the vagina. This procedure involves the detachment of the uterus from the upper vagina, fallopian tubes and ovaries along with the connective tissue and blood vessels that support it. It is at this point that the uterus can be removed. The procedure is performed with the use of long instruments that clamp uterine blood vessels to separate the uterus. Absorbable stitching is added to keep pelvis bleeding under control.

Our doctors, Arathi Veeraswamy, MD and Brooke Maclennan, CNM, are here to determine if you are a candidate for a vaginal hysterectomy or an abdominal hysterectomy. The purpose of a vaginal hysterectomy is to treat gynecological problems ranging from endometriosis to fibroids, gynecological cancer, uterine prolapse, uterine bleeding, chronic pelvic pain and adenomyosis. However, a hysterectomy is just one of many options available to reduce pain and improve biological health moving forward. Our doctors will determine if medications or a comparably less invasive procedure is the better approach. It must be noted that a woman cannot give birth to a child after a hysterectomy.

Anterior and Posterior Vaginal Repair

If your pelvic organs move out of their regular positions, Arathi Veeraswamy, MD and Brooke Maclennan, CNM at Reno Tahoe Women's Health can help. We perform anterior and posterior vaginal repair to correct the dropping of pelvic organs. These procedures are optimal for patients who suffer pelvic organ prolapse to prevent a permanent discomfort, pressure and bowel/urinary dysfunction resulting form a vaginal bulge. The procedure tightens support tissue to keep the organs in position, restoring their functionality and positioning. The anterior repair is performed to tighten the anterior vaginal wall after the bladder moves out of its regular position and protrudes to the front part of the vagina, leading to sagging.

The surgery involves pushing the bladder back to its regular position and reinforcing the tissue between the bladder and vagina. Posterior repair tightens the vagina’s back wall. This procedure is performed after the rectum has moved out of its regular position and bulges toward the back part of the vagina. The posterior repair surgery pushes the rectum back to the regular position, reinforcing the support tissue between the rectum and back part of the vagina. Both of these procedures are performed after childbirth and the aging process, bolstering the functionality of pelvic organs for enhanced comfort across posterity.

Vaginal Vault Suspension

Vaginal vault suspension is a surgical procedure that repairs a prolapsed vaginal wall. This surgery rectifies structures that provide support for the vaginal vault in a manner that readjusts its position for optimal functionality. However, conservative options will be explored before resorting to a vaginal vault suspension. The doctors at Reno Tahoe Women's Health will consider vaginal pessaries as well as pelvic floor exercises prior to resorting to a vaginal vault suspension.

The vaginal vault suspension procedure requires admission to the hospital the night prior to the surgery. The procedure reattaches the vaginal vault that has prolapsed to the elevated sections of ligaments connected to the uterus. This reattachment is achieved with the use of permanent stitching or a synthetic mesh.

You won’t feel pain during the procedure as anesthesia is applied to numb the pelvic area. The surgeon will perform the procedure through the abdomen or vagina. Your age, prior surgical history, health, frequency of physical/sexual activity and the presence of other diseases all play a part in determining the surgical approach best for you.