When the natural tissue and ligaments that hold pelvic structures in place begin to fail, it is called Pelvic Organ Prolapse (POP). It occurs with descent (sagging/drooping) of one or more pelvic structures: the uterus/cervix (metrocele/uterovaginal prolapse), vaginal cuff (vaginal cuff prolapse), anterior vagina/bladder (cystocele), posterior vagina/rectum (rectocele), or peritoneum of the cul-de-sac/small intestine (enterocele). When complete prolapse occurs which shows a large multi-inch protrusion through the vaginal opening including bladder, uterus and bowel, it is called procidentia. Patients complain of vaginal bulge which significantly affects their quality of life, including obstruction in emptying the bladder, difficulty to close the legs and sitting.
For patients who are no longer having vaginal intercourse, do not desire to use a pessary, a pessary has been unsuccessful, or desire to avoid mesh usage, there is a surgical procedure called Colpectomy/Colpocliesis. This is a vaginal surgery (with or without vaginal hysterectomy) which effectively eliminates the prolapse and results in a shortened and narrowed vagina. It may be done under general anesthesia without intubation or regional (spinal or epidural) anesthesia and takes about 1-1.5 hours to perform. Usually patients do not need to stay overnight in the hospital, are encouraged to ambulate immediately but required to avoid heavy and/or abrupt lifting for six weeks.