Pelvic organ prolapse is a condition during which your pelvic floor muscles, ligaments, and tissues support your pelvic organs are too weak to hold your organs in place. 

What Are the Symptoms of Pelvic Organ Prolapse? 

The common symptoms include: 

• Bulge, fullness or pressure in your vagina. 

• Fullness and pressure in your pelvis. 

• Pain in the lower back. 

• Pain during intercourse. 

• Vaginal spotting. 

How is Pelvic Organ Prolapse Treated? 

A pelvic organ prolapse is treated by: 

• Non-surgical treatments:  

This includes a removable silicone device called vaginal pessary or exercises. 

• Surgery: 

This includes sewing your vaginal walls to prevent organs from slipping out. It can be done by: 

• Colpocleisis: obliterative procedure that results in a shortened vagina. It prevents any organs from bulging outside your body. It’s a good option if you’re too frail for reconstructive surgery and don’t wish to have penetrative sex anymore. 

• Colporrhaphy: treats anterior and/or posterior vaginal wall prolapse. With colporrhaphy, your healthcare provider performs surgery through your vagina. They reinforce your vaginal walls with dissolvable sutures to support your bladder and rectum. 

• Sacrocolpopexy: treats vaginal vault prolapse and enterocele. It may involve an incision into your abdomen or a less invasive procedure, called laparoscopy. During the procedure, your provider attaches surgical mesh to your vaginal walls and then attaches it to your tailbone. The mesh lifts your vagina back into place. 

• Sacrohysteropexy: treats uterine prolapse. Your provider attaches surgical mesh to your cervix and vagina and attaches it to your tailbone, lifting your uterus into place. Sacrohysteropexy is an option if you don’t want to have your uterus removed.

Urodynamic Testing 

Urodynamic testing involves a series of tests that diagnose issues with your urethra, bladder, urinary sphincter, and urinary tract.  

Why Do You Need Urodynamic Testing? 

You may require urodynamic testing if you have: 

• Pain while peeing. 

• Sudden urge to pee. 

• Urinary incontinence. 

• Urinary retention. 

• Slow urine flow. 

• Neurogenic bladder. 

• Spine injury or surgery 

What Are the Types of Urodynamic Tests? 

Depending on your condition, a urologist may recommend any of the below tests: 

• Cystometry: 

During this test, a catheter may be used to measure pressure inside your bladder, contractions or spasms of your bladder wall. Your urologist will insert a catheter called a manometer into your bladder through the urethra to measure bladder pressure.  

Following this, the warm and sterile solution will be filled in your bladder. You may be asked to cough to record leak point pressure.  

• Electromyography: 

Electromyography uses sensors to measure the electrical activity of muscles and nerves in and around your bladder. During this test, electrode patches are applied near your urethra and rectum to record electrical currents when muscles in your pelvic floor contract. 

• Uroflowmetry: 

This test is done to analyze how quickly you pee. To do this, you will be asked to pee into a machine that will measure the amount and flow rate of your pee. 

• Postvoid Residual Measurement: 

This test measures the amount of pee left in your bladder when you empty it. It involves a bladder scan to evaluate how much urine is in your bladder. 

• Video Urodynamic Tests: 

This test involves a combination of cystometry, uroflowmetry, and X-ray to measure urine flow and pressure in your bladder and rectum by using X-rays. 

What Happens After Urodynamic Testing? 

After the procedure, you may have mild discomfort or soreness when you pee which may subside after a few hours. 

Interstitial cystitis or bladder pain syndrome refers to severe pain, pressure, and discomfort in your bladder. It also involves a sudden urge to pee for at least 6 weeks. 

What Are the Symptoms of Interstitial Cystitis? 

The common symptoms include: 

1. Pain in your bladder. 

2. Extreme pressure or discomfort when your bladder is filling. 

3. Urinary urgency. 

4. Increased frequency of urinating. 

5. Peeing only a small amount. 

How is Interstitial Cystitis Treated? 

Unfortunately, there is no cure for interstitial cystitis. Your doctor, however, can help you in managing the symptoms. This includes: 

• Dietary Changes: 

Some people with interstitial cystitis may find certain foods or drinks triggering their symptoms. To find this out, keep a note of what and how much you eat and drink throughout the day and observe your symptoms closely. 

Try to avoid anything that may trigger your symptoms. Common foods that are known to trigger are: 

1. Alcohol. 

2. Carbonated beverages. 

3. Fruit juices. 

4. Chocolates. 

5. Tomatoes. 

6. Artificial sweeteners. 

• Physical Activity: 

Make sure that you also take some time out for physical activity. This includes walking, bicycling, or yoga. 

• Bladder Retraining 

If you have bladder pain, it’s very likely for you to use the bathroom as soon as you feel like peeing or even if you don’t feel like peeing. Your body may get used to the pattern and eventually, you will keep using the bathroom more often. 

To practice bladder retraining, keep a note of how often you use a bathroom and how often you feel like peeing. Train yourself to slowly decrease your bathroom breaks. 

• Oral Medications: 

Certain medications may also help you reduce the pain and relieve your interstitial cystitis symptoms. 

• Surgery: 

If non-surgical treatments fail, your doctor may recommend surgery and remove a part or all of your bladder known as cystectomy. 

Fistulotomy 

A fistulotomy is a surgical procedure to treat a fistula. A fistula occurs when two of your organs or vessels form an abnormal connection. An anal fistula occurs when your perianal skin forms an abnormal connection with the surface of the anal canal. 

What Happens During the Procedure? 

Fistuolotomy is a minor surgery and takes about an hour to complete. During the procedure, the surgeon will make an incision to open up the abnormal connection between the two organs and close the incisions. 

What Happens After a Fistulotomy? 

After the procedure, you can go back home on the same day and follow all the instructions given by your surgeon. 

Pelvic floor physical therapy refers to urinary incontinence skills that they need to regain bladder control. It works by improving the strength and function of the muscles that support the bladder, urethra, and other pelvic organs. 

How Can Pelvic Floor Physical Therapy Help You? 

Pelvic floor physical therapy can help you by: 

1. Strengthening your pelvic floor muscles. 

2. Bladder and bowel symptoms. 

3. Childbirth preparation and recovery post birth. 

4. Core stability and back problems. 

5. Prolapses. 

What is Included in the Pelvic Floor Physical Therapy? 

Pelvic floor physical therapy is aimed to provide a complete physical assessment which includes manual vaginal or rectal examination, pelvic floor retraining, electrotherapy, education, and advice. 

Pelvic Floor Muscle Retraining 

This is the most important part of pelvic floor physical therapy which includes awareness techniques to help you with right pelvic floor exercises. This retraining helps you identify and activate the right muscles, control your overactive muscles, and integrate your daily activities and sports. 

Manual Therapies 

Manual therapies aim to relax, lengthen, mobilize, and alleviate pain. This includes internal vaginal and rectal techniques to treat your muscles, ligaments, tendons, nerves, and joints. 

Electrotherapy 

This includes muscle electrostimulation to increase awareness and re-train extremely weak pelvic floor muscles to work properly. 

Patient Education 

This includes educating you about your condition and providing required tips and advice on lifestyle changes, diet modifications, behaviour, and so forth. 

A vaginal pessary or pessary is a removable device that is inserted in the vagina to support your pelvic organs. This is indicated when you have pelvic organ prolapse during which your pelvic floor becomes weak and slips out of place. 

Why Do You Need a Pessary? 

You may need a pessary if you have: 

• Pelvic organ prolapse. 

• Urinary incontinence. 

How is a Pessary Fitted? 

During the procedure, your gynaecologist will: 

• Perform a pelvic exam and examine your vagina and other pelvic organs including the size of your vaginal opening, the length of the vaginal canal, and the severity of prolapse. 

• Based on the examination, the gynaecologist will determine the type and size of pessary you need. 

• Insert gently insert the pessary. For your comfort, the pessary will be lubricated to help it slide easily. 

• Ask you to stand, sit, and walk to check if the pessary stays put. 

How To Take Care of the Pessary? 

Pessary can easily be removed and worn on your own. You can remove it and clean it weekly. This includes: 

• Wash your hands with soap and gently pull out the pessary. 

• Wash it with mild soap and water. 

• Rinse and dry it before re-inserting. 

If you find it difficult, you can visit your gynaecologist for the same. Mostly, your gynaecologist will set up follow-up visits to ensure that the pessary is not scraping or scarring your vaginal walls. 

What Are the Risks Associated with Pessary? 

Pessary is generally safe with minimal risks. It may, however, cause: 

• Pain or discomfort. 

• Bloody discharge. 

• Unusual vaginal odour.