Pelvic Organ Prolapse: Should I Have Surgery?

Pelvic organ prolapse occurs when a pelvic organ, such as your bladder, drops (prolapses) from its normal spot in your lower belly and pushes against the sides of your vagina. This can happen when the muscles that hold your pelvic organs in place get weak or damaged from childbirth, for example.

More than one pelvic organ can prolapse at the same time. Other organs that can be involved when you have pelvic prolapse include your:

• Urethra.
• Uterus.
• Vagina.
• Small bowel.
• Rectum.

Pelvic organ prolapse usually causes only mild symptoms. Surgery is usually done only when the prolapse is affecting your daily life and your doctor thinks surgery will help. Consider surgery if:

• The prolapse causes pain.
• You have problems with your bladder and bowels.
• The prolapse makes it hard for you to do activities you enjoy.

Many kinds of surgery can be done for pelvic organ prolapse. The type of surgery you have will depend on which organs are prolapsed.

Types of surgery include:

• Surgery to repair and restore the tissue in the area of the prolapse (restorative surgery).
• Surgery to close the vagina (vaginal obliteration). This surgery is only an option if you no longer want to have vaginal sex.
• Removal of the uterus (hysterectomy).

During restorative surgery for bladder, urethra, rectum, and small bowel prolapse, the surgeon makes a cut, called an incision, in the wall of the vagina. The surgeon pulls together the loose or torn tissue in the area of the prolapsed organ and strengthens the wall of the vagina to keep the prolapse from coming back.

During restorative surgery for vaginal vault prolapse, the surgeon makes an incision in the wall of the vagina. The surgeon attaches the top of the vagina to the wall of the lower belly, to the spine in the lower back, or to the ligaments of the pelvis.

During a hysterectomy, the surgeon removes the uterus.

During a vaginal obliteration, the surgeon removes most of the vaginal lining and then sews the vagina shut. If you still have a uterus, the doctor leaves a small opening to allow fluid to drain from the uterus.

These surgeries are usually done by a gynecologist or a urologist. You will have medicine to make you sleepy during the surgery (anesthesia). You may stay in the hospital for a day or two. You may go home with a catheter, a flexible plastic tube that drains urine from your bladder when you can't urinate by yourself.

After surgery, you will likely be able to return to your normal activities in about 6 weeks.

For the first 3 months after surgery, you will need to take it easy and avoid heavy lifting or long periods of standing. Your prolapse can return if you strain or lift too soon after surgery.

It may be best to delay surgery if you plan to get pregnant in the future. The strain of childbirth could cause your problem to come back.

Problems you may have after surgery can include:

• Trouble controlling your bladder (incontinence).
• Not being able to empty your bladder.
• Pain during sex.
• Infection.
• Bladder injury.
• A hole or opening that forms between two organs in your body, or between your body and your skin. This is called a fistula.

Since surgery for pelvic organ prolapse is done to treat symptoms caused by one prolapsed organ, you may still have other symptoms after your surgery.

Pelvic organ prolapse can come back after surgery. How well surgery works depends on the type of surgery. But about 5 to 20 out of 100 people have a second surgery within 3 years.^{footnote 1, footnote 2} This means that about 80 to 95 out of 100 people don't have a second surgery within 3 years.

You may be able to relieve some symptoms of pelvic organ prolapse on your own.

• Try exercises called Kegels to make your pelvic muscles stronger.
• Ask your doctor about pelvic floor physiotherapy. A specialized physiotherapist can help you with exercises and may use other techniques to help your symptoms.
• Eat foods that are high in fibre to avoid constipation and straining when you have a bowel movement.
• Reach and stay at a healthy weight, since more weight puts pressure on your pelvic muscles.
• Avoid lifting heavy things that put stress on your pelvic muscles.

If you choose, your doctor can fit you with a device called a pessary. A pessary can help you cope with pelvic organ prolapse. It's a removable device that you put in your vagina. It holds the pelvic organs in place. Pessaries can be useful if you don't want or can't have surgery. Many people can control their symptoms for years by using a pessary.

Your doctor may encourage you to have surgery for pelvic organ prolapse if:

• Your symptoms are painful or are affecting your quality of life.
• Non-surgical treatments, such as using a pessary or special exercises, have not helped or you don't prefer them.