Pelvic problems

Pelvic prolapse: New treatments available



To make an appointment with Dr. Davila at Cleveland Clinic Florida, call 954-659-5000.

To make an appointment with Dr. Yavagal at UM Hospital, call 305-243-4530 or email

For Sheri Smith, her pelvic problems got progressively worse over five years, even after having a hysterectomy in 2010.

But that all changed for the 57-year-old when she was treated less than two months ago at Cleveland Clinic Florida, where she had a sling inserted into her bladder to alleviate her incontinence and a surgical procedure to repair her pelvic organ prolapse.

“One procedure changed everything,” Smith said. “Immediately I was much more secure walking around.”

Pelvic organ prolapse can be considered a type of herniation to the vagina in which the pelvic organs — the uterus, bladder or rectum — descend or shift within the pelvis, and in some cases, protrude outside of the vagina.

According to the National Association for Continence, nearly 50 percent of women who have given birth will develop some form of pelvic issue. Symptoms include feeling pressure against the vaginal wall, fullness in the lower part of the stomach, a bulge in the rectum or vagina, urinary incontinence, pain during sex and problems with bowel movements.

Dr. Guillermo Davila, a gynecologist and chairman of Cleveland Clinic Florida’s gynecology department, said the condition wasn’t openly discussed until recently.

“It was a bit of a taboo subject to have somebody’s uterus or their bladder or their rectum kind of fall out,” he said.

Genetics, childbirth, aging and obesity are four of the most common factors associated with prolapse. Exercising, lifting heavy objects and “trying to be everything for everyone,” he added, contribute to the condition’s development.

Pelvic floor physiotherapy and inserting a pessary are the two most common non-surgical procedures. Therapy is done to strengthen the pelvic core muscles and the pessary holds the organs in place.

As for surgical options, robotic sacrocolpopexy has become the most popular procedure since the Food and Drug Administration released strict regulations regarding vaginal mesh procedures in 2011. This type of surgery is a minimally invasive procedure where small incisions are made to the lower abdomen and a small piece of mesh is used to secure the cervix, vagina and bladder to the sacral bone.

Mesh used in the abdomen carries much less of a risk than mesh used in the vagina, said Dr. Sujata Yavagal, a gynecologist at the University of Miami Hospital.

“The first thing we start with is pelvic therapy,” Yavagal said. “A lot of patients don’t know about this because everyone thinks that if they have prolapse or incontinence they are going to need surgery, but that is not really true.”

Yavagal recommends that women speak to their doctors as soon as they feel any symptoms.

“If you had a cold that wasn’t going away, would you stay home?” she said. “There is absolutely no necessity to suffer just because you’re embarrassed to talk about it or you don’t think there is a treatment available. There are excellent treatment options.”

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