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www.FredericksburgParent.NET 29 Women 50 and older are the most common group to experience this condition, but some may experience it earlier. A history of vaginal deliveries is one of the biggest contributing factors to this condition. It can still happen with patients who have only had C-sections, but it is far less common. The more deliveries that a woman has had, and the bigger the babies, the more stretching and damage are done to the pelvic floor structures. Once that dam- age is done, time and gravity take effect. So do hormones. After menopause, the ovaries are no longer producing estrogen, which is beneficial to the vaginal walls and supportive tissues. Other risk factors include: • Smoking, which negatively impacts the strength of connective tissues. • Chronic conditions such as COPD and asthma that cause frequent coughing fits, which push down on this tissue. • Obesity. • Very physical, strenuous work that requires heavy lifting. Q: How is pelvic organ prolapse diagnosed? Dr. Walker: In the office, we will do an exam and can assess what exactly is prolapsing. We look at whether the walls of the vagina are prolapsing from the sides, the posterior or both. We also look at whether the uterus is descending into the vagina, a condition called uterine vaginal prolapse. The exam is done by an OB/GYN, although patients who are experiencing primarily urinary symptoms may see a urologist first. Q: What treatments are available? Dr. Walker: For women in their 30s and 40s who experience symp- toms, pelvic floor physical therapy can be beneficial, which is avail- able at Spotsylvania Regional Medical Center. We do see this as an option for some patients over 50, as well. Another option available for some patients is a pessary, which is a removable silicone device that is inserted into the vagina to hold organs in place. For many patients, a surgical procedure called laparoscopic hyster- ectomy and sacrocolpopexy can provide long-term relief. This is a minimally invasive surgery performed within Spotsylvania Regional Medical Center's robotic-assisted surgery program. The procedure is performed collaboratively with a board-certified urologist, so patients will see both specialists in preparation for surgery. Q: What are the advantages of robotic-assisted surgery? Dr. Walker: Robotic-assisted surgery offers high-resolution, three- dimensional optics that allow surgeons to get a better visualization, with depth perception, of the area in which they are working. For patients, these minimally invasive procedures lead to reduced pain and discomfort, shorter recovery times and shorter hospital stays, so they can get back to normal life faster. The small incisions used in these procedures result in a lower risk of infection, reduced blood loss and less scarring. Spotsylvania Regional Medical Center has a robust robotics program and offers many different surgeries on this platform. Q: What does the procedure look like from the patient's perspective? Dr. Walker: Laparoscopic hysterectomy and sacrocolpo- pexy is performed as an outpatient procedure, half of patients will be able to go home the same day with the other half of patients staying one night in the hospital for observation. Patients are placed under general anesthesia. The procedure is performed laparoscopically through five small incisions in the abdomen. Time in surgery is usually 1.5 to 2 hours. Patients typically have some soreness and need to take things easy at home for 3 to 5 days. Most patients have minimal pain and normal range of movement after 7 days, and feel back to normal after two to three weeks. Heavy lifting is typically restricted for 6 weeks. Patients follow up with both surgeons post-op to ensure they are doing well. Q: What do patients notice after this procedure? Dr. Walker: Patients remark on their ability to resume a lot of physical or daily activities that they had previously avoided because of the symptoms of prolapse. They have more freedom of movement, can stay on their feet longer and really do see an improvement in quality of life. It's important for patients to know that this minimally invasive solution is available. I think a lot of times, patients feel that the symptoms they are experiencing are just part of life, and they may not know what options are available or fear a difficult recovery. My partner urolo- gist and I have been able to take this minimally invasive approach—we've been performing these surgeries roboti- cally for 10 years now—which has had a dramatic impact on patient success, with limited pain and speedy recovery. The improvement of quality of life really is the goal here. Scott Walker, MD, FACOG, board-certified OB/GYN Pratt Medical Group of HCA Virginia Physicians To learn more about Pratt Medical Group, visit prattmedicalgroup.com.

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