Pelvic organ prolapse is a very common condition affecting women of all ages. It occurs when the connective tissue that supports the bladder, uterus, top of the vagina after hysterectomy, or rectum becomes lax and leads to dropping of these organs. Women who have pelvic organ prolapse often experience a bulge inside the vagina. They may feel this throughout the day or when they wipe after using the restroom. Some women just feel pressure in the pelvic area as the day progresses. It may even cause it to be difficult to empty the bladder or bowels without pushing on or around the prolapse. Some women may not even know it is there!
I have Pelvic Organ Prolapse. Is surgery the only option?
There are three options for how to treat your prolapse.
- Nothing – Prolapse is not life threatening. If it does not bother you, you could live your entire life with it and never miss a beat!
- A pessary – This is a firm silicone device that is placed inside the vagina to hold the prolapse in place. Pessaries are a great option for someone who does not want to have surgery or who is not a great candidate for surgery because of underlying health problems. Pessaries do not work for every type of prolapse, but they are always worth trying if you would like to avoid surgery. Pessaries require follow up because there is risk of the pessary causing pressure ulcers inside the vagina. They must be removed and cleaned at least every 3 months. Some patients feel comfortable removing and cleaning their pessary on their own, and they only need a yearly follow-up exam.
- Surgery – Many patients desire to have surgery to correct the prolapse so that they do not have to worry about it anymore. They want to live their lives without worrying about anything falling down!
I want to have surgery for my prolapse. What does this entail?
For most patients who have never had a surgery before to correct the prolapse, a vaginal approach will be taken. You will have no incisions on your abdomen. The entire surgery will be done through the vagina. If you have not already had a hysterectomy, the surgeon will remove your uterus through the vagina. The surgeon will then attach the top part of the vagina to a strong ligament in the abdomen, so that it cannot fall down. The surgeon will support the bladder by bringing together strong connective tissue that acts as a “wall” of connective tissue and scar tissue to hold up the bladder. This is also how the rectum can be supported by using your own connective tissue. This technique does not use any vaginal mesh to support the prolapse. If you have had previous surgery to correct your prolapse, and your prolapse came back, you may need more extensive surgery involving mesh placed through the abdomen, which is not included in the FDA warnings you hear about on television.
What is the recovery like?
We recommend a 6-8 week recovery after vaginal surgery to correct prolapse. The reason for this is because it takes 6-8 weeks for the stitches inside the vagina to dissolve and 6-8 weeks for the scar tissue that supports the prolapse to completely form. You will be restricted to no lifting more than 10 pounds for 6 weeks and no intercourse for 6 weeks after surgery. We encourage patients to walk the day of their surgery and to continue walking daily during their recovery. We discourage any activity more strenuous than walking after surgery. During recovery, it may take time for your bowels and bladder to get back to normal because all of the nerves that go to the bladder, vagina, and bowels are inter-related. Some patients have trouble with emptying their bladder and may need to catheterize for a short time after surgery. Some patients who have trouble with constipation may require medications throughout the entire recovery. These issues most commonly resolve.
It is important to remember that pelvic organ prolapse is not an emergency, and you do not need surgery right away if you have prolapse. Many women live with prolapse for many years before having surgery. We gauge when you should have surgery based on how bothered you are by the prolapse, and when is a good time in your life to have a surgery with a long 6-8 week recovery. Discuss all of this with your family before making your final decision. Remember, they will be the ones that have to help you during that 6 weeks of no lifting and limited activity!