Pelvic organ prolapse (POP) happens when organs like the bladder, uterus or rectum drop down and press against the vagina. It can be shocking when this happens to you, but take heart: there are several ways to treat this condition -- both with and without surgery.
- Pessary. This is probably one of the first treatments your doctor will recommend if you have symptoms of POP. A pessary is a device (it looks like a ring) that’s inserted into your vagina. It helps to support, or hold up, your pelvic organs. You’ll need to be fitted for one in your doctor’s office. It’s a lot like being fitted for a diaphragm.
- Kegel exercises. These strengthen your pelvic muscles. They’re very easy to do. Imagine you have to pee, but instead of letting it out, you squeeze to hold it. Do this for 5 seconds, relax, then do it again. Do 10 sets of these up to 15 times per day. Work up to 10 seconds, 20 repetitions, 3 times per day. Over time, your prolapse may get better or disappear altogether.
- Biofeedback therapy. This treatment combines teaching you how to contract your pelvic muscles with proper breathing techniques and abdominal control.
If your symptoms are severe and nonsurgical treatments haven’t helped, you may want to consider surgery. There are two types of prolapse surgery: obliterative and reconstructive.
Obliterative surgery narrows or closes off part or all of the vagina. The goal is to provide more support to the organs that have dropped out of their normal positions and are pressing against the walls of the vagina. This may be an option if surgery hasn’t worked and you can’t tolerate another procedure, or if you are not healthy enough to have bigger surgery to correct the problem. After this operation you will no longer be able to have intercourse.
Reconstructive surgery aims to repair the pelvic floor and return organs to their original position. This can be done with cuts either in the vagina or the abdomen. It can also be done using laparoscopic surgery, in which a surgeon makes smaller cuts in the abdomen and uses special instruments.
There are a number of reconstructive surgeries your doctor can perform to restore the appearance and function of your pelvic organs. They include:
- Sacrospinous ligament fixation and uterosacral ligament suspension. This procedure is designed to improve the support to the uterus or vaginal vault. Your own tissue (or vaginal mesh, discussed below) is used to fix or suspend the sagging pelvic organs. Your surgeon will make a cut in the vagina and use stitches to attach the vaginal vault to a ligament in the pelvis. The stitches may be permanent or dissolve over time.
- Anterior and posterior colporrhaphy. The goal here is to make the tissue that holds the pelvic organs in place tighter and stronger. Anterior repair is used when the bladder drops and presses against the front of the vagina. Posterior repair is used when the rectum drops and pushes into the back of the vagina. This procedure is also done through the vagina by using your own tissues or vaginal mesh to repair the prolapse.
- Sacrocolpopexy and sacrohysteropexy. These procedures use surgical mesh to fix and anchor organs that have dropped down. Sacrocolpopexy is used to repair prolapse of the vaginal vault. Sacrohysteropexy is used to fixed prolapse of the uterus. These operations are done with cuts in the abdomen. They can also be done laparoscopically.
- Vaginal mesh repairs prolapse by putting mesh under the vaginal skin to help lift sagging organs into place.
Does Surgery Really Work?
The success rate for sacrospinous ligament fixation and uterosacral ligament suspension is 80% to 90%. Sacrocolpopexy and sacrohysteropexy have about the same success rate. Studies show vaginal mesh surgery works about 80% to 95% of the time. But even then, there’s a chance another part of the vagina may prolapse.
What Can I Expect After Surgery?
Recovery time depends on the type of surgery you have. In general, you should plan to take a few weeks off from work. You should also avoid sex and vigorous exercise or activity for at least 6 weeks. It typically takes longer to recover from abdominal surgery than it does from vaginal surgery.
With vaginal surgery, you may get a creamy white discharge for 4 to 6 weeks afterward. This is because of the stitches in the vagina.
What Are the Risks of Surgery?
You may have:
- Pain during sex
- Pelvic pain
- Trouble holding your pee (urinary incontinence)
Pelvic organ prolapse surgery also carries the same risks as most operations: infection, bleeding and blood clots. Your doctor could also injure nearby organs during the procedure.
With mesh placed in the vagina, there’s a risk of pain and infection, and also that the mesh will erode. In 2016, safety concerns prompted the FDA to classify vaginal mesh for pelvic organ prolapse as a “high-risk device.” You probably would only have this procedure if:
- You’ve tried other prolapse surgery without success.
- Your tissues are too weak to repair.
- You can’t have abdominal surgery.