Expert Advice: Is Pelvic Organ Prolapse Surgery Right for You?

Pelvic organ prolapse is a condition in which one or more organs in the pelvis are affected. They move from their normal positions into the vaginal canal. In cases where non-surgical interventions and lifestyle modifications aren’t effective, pelvic organ prolapse surgery may be considered. There are several types of prolapse surgeries. They aim at restoring the anatomy and function while addressing the uncomfortable symptoms of prolapse. 

We call Pessary the device placed into the vagina to support the uterus or bladder and rectum. Its used as a first solution before surgery.

An Overview of Pelvic Organ Prolapse 

Pelvic organ prolapse or POP is due to the weakening of muscles and tissues of Pelvic organs. Organs include vagina, uterus, bladder, urethra, and rectum.

Pelvic Organ Prolapse Symptoms

Symptoms of pelvic organ prolapse include a feeling of heaviness around the lower abdomen and genitals. Also discomfort during intercourse, urinary issues, and bowel-related symptoms. 

The four types of pelvic prolapse are: 

1. Cystocele: Prolapse of the bladder into the front wall of the vagina. 
2. Rectocele: Prolapse of the rectum into the back wall of the vagina. 
3. Uterine Prolapse: Sinking of the uterus into the vaginal canal. 
4. Enterocele: Prolapse of the small intestine into the upper vaginal wall. 
5. Vaginal Vault Prolapse: Prolapse of the top of the vagina into the vaginal canal. 

Although pelvic organ prolapse isn’t life-threatening, it can cause pain and discomfort. Therefore, it’s essential to take proper medical assistance when symptoms arise. 

When Is Pelvic Organ Prolapse Surgery Necessary?

Surgery becomes necessary when nonsurgical treatments fail to relieve symptoms and the prolapse significantly impacts the individual’s quality of life. Several factors influence the decision to undergo surgery. Symptom severity, type and extent of prolapse, and its effect on daily activities are some of these factors. The patient’s overall health also plays a crucial role.

Here are some of the factors that may indicate the need for surgical intervention: 

• Symptom Severity:
  Surgery may be recommended if the symptoms of pelvic organ prolapse are severe and cause a serious impact on daily life. 
• Impact on the Quality of Life:
  We may consider surgery when pelvic organ prolapse hinders daily activities and poses significant discomfort to improve quality of life.
• Failed Conservative Treatment:
  If conservative or nonsurgical treatments like pelvic floor exercises, pessaries, and lifestyle modifications fail to relieve symptoms, pelvic organ prolapse surgery can be a viable option. 
• Urinary or Bowel Dysfunction:
  Surgery may be recommended if pelvic organ prolapse is causing urinary or bowel dysfunctions. 
• Recurrent Prolapse:
  If the individual experiences recurrent or worsening prolapse despite nonsurgical treatments.
• Uterine Prolapse and Desire for Hysterectomy:
  In cases of uterine prolapse in women who have completed their childbearing and desire a hysterectomy [removal of the uterus], surgery may be a favorable option. 
• Impact on Sexual Function:
  When symptoms of pelvic organ prolapse are hindering sexual experience

Your surgeon bases the decision to undergo pelvic organ prolapse surgery on several factors aforementioned. It’s crucial that the healthcare professional evaluate the specific conditions and discuss the possible surgical options, risks, and outcomes before making any recommendations. 

Types of Pelvic Organ Prolapse Surgery 

There are several prolapse surgeries.

Vaginal Colpopexy: 

• Sacrocolpopexy:
  Sacrocolpopexy is a surgical procedure that attaches synthetic mesh or graft at the top of the vagina and secures it to the tailbone to provide added support. It is often performed robotically or laparoscopically.
  

Anterior and Posterior Repair:

• Anterior Colporrhaphy: Anterior colporrhaphy is a surgical procedure that addresses cystocele, a condition where the bladder sinks into the front of the vaginal wall. 
• Posterior Colporrhaphy: Posterior colporrhaphy is a surgical procedure that addresses rectocele, a condition where the rectum sinks into the back wall of the vagina.
  

Uterine Preservation Procedures:

• Uterosacral Ligament Suspension: This is a surgical procedure that attaches the uterosacral ligaments [essential structures that support the uterus and the uppermost part of the vagina] to the back of the cervix or top of the vagina to provide added support. 
• Sacrospinous Ligament Suspension: This procedure attaches the top of the vagina to the sacrospinous ligaments [a thin strong ligament between the pelvis and sacrum] to provide additional support.
  

Hysterectomy: 

• Vaginal Hysterectomy:
  To address the prolapse in cases where the uterus is involved, the surgeon performs a vaginal hysterectomy along with supplementary repairs. 
• Abdominal Hysterectomy:
  Abdominal hysterectomy is a surgical procedure where the uterus is removed through an abdominal incision and additional prolapse repairs are performed during the surgery.
  

Perineorrhaphy: 

• Perineorrhaphy or Perineoplasty:
  Perineoplasty is a surgical procedure focused on repairing the perineum, the area between the vagina and anus. It is typically done in conjunction with other prolapse repairs.
  

Colpocleisis:

• Colpocleisis involves closing a portion of the vaginal wall and shortening the vaginal canal. Surgeons typically recommend this procedure for older women who don’t wish to preserve sexual function and need a definitive solution to prolapse.

It’s essential for individuals planning a prolapse surgery to carefully consider the different options with their doctor. 

Recovery and Rehabilitation After Pelvic Organ Prolapse Surgery 

Adequate rest and rehabilitation are crucial for successful outcomes and minimal complications. Although recovery varies according to individuals and their conditions, here are some general guidelines for care after pelvic organ prolapse surgery: 

• Rest: During the early weeks after the surgery, it’s important to get adequate rest and avoid overexertion. 
• Pain Management: Consider over-the-counter pain medications to relieve discomforts associated with surgery. 
• Hygiene: Although it’s essential to maintain good hygiene after the surgery, it’s generally recommended to shower and wait a week before taking a bath. Gently pat the incision dry. 
• Activity Modification: It’s important to avoid strenuous activities like heavy lifting to prevent complications after surgery. 
• Lifestyle Modifications: As the body gradually returns to normal activities, it’s important to give the body its time to properly health. 
• Follow-Up Care: Schedule regular follow-up appointments with the healthcare provider to monitor progress and address any concerns. 
• Physiotherapy: Consider meeting a physiotherapist who specializes in pelvic health to regain strength, flexibility, and mobility in the treated area. 

Apart from these general guidelines, it’s important to follow the personalized plan as recommended by the healthcare provider to see results. 

Expected Outcomes of Pelvic Organ Prolapse Surgery 

The primary aim of all pelvic organ prolapse surgeries is to restore anatomy and function in addition to relieving the symptoms of prolapse. Here are some of the expected outcomes after prolapse surgeries: 

1. Improvement of Symptoms: As expected, the fundamental goal of the surgery is to reduce the uncomfortable symptoms associated with pelvic organ prolapse. After surgery, most patients experience a reduction in symptoms. 
2. Enhanced Quality of Life: With symptoms addressed and support restored, patients experience a better quality of life and can resume back to their normal routine with comfort. 
3. Restoration of Support: As surgical procedures aim to restore the support, further prolapse is prevented thus improving the overall function. 
4. Long-Term Success: According to research, certain prolapse surgeries offer long-term success rates. For instance, abdominal sacrocolpopexy offers an impressive rate of 80-95% in restoring the position of the pelvic organs. 
5. Prevention of Recurrent Prolapse: Successful surgery eliminates recurrent prolapse and the need for additional surgeries. While some patients require a second surgery within three years of the first one, most patients don’t require further intervention. 
6. Preservation of Sexual Function: For individuals whose sexual function was hindered due to pelvic prolapse, surgery can help enhance and preserve the sexual function. 

It’s crucial to note that the outcomes vary based on individuals and their conditions. 

Associated Risks of Pelvic Organ Prolapse Surgeries 

As with all surgical procedures, pelvic organ prolapse surgeries also carry some potential risks and concerns. Some of the common risks are as follows: 

1. Mesh-Related Complications: Surgeries that use mesh pose significant risks, including mesh erosion, pain, infection, and bladder or bowel injury. 
2. Infection: As the risk of infection comes with any surgery, prolapse surgeries are no exception. 
3. Bleeding: There is a risk of bleeding during or after the surgery, thus requiring additional treatment. 
4. Injury to Nearby Structures: Some of the rare complications related to prolapse surgeries are injury to the nearby structures like bowel, bladder, or nerves. 
5. Recurrence of Prolapse: While prolapse surgeries are mostly successful, in some cases, the patient may require further surgical intervention. 
6. Urinary or Bowel Dysfunction: Prolapse surgery may cause urinary or bowel dysfunction like recurring urinary tract infections or difficulty emptying the bladder. 
7. Pain: Although rare, some patients may experience long-term pain after prolapse surgery. 

It’s always advisable to understand the risks associated with prolapse surgery before undergoing the procedure. 

What are the Non-Surgical Treatments for Pelvic Organ Prolapse?

Non-surgical methods are often the first line of treatment for pelvic organ prolapse, particularly for individuals with mild to moderate symptoms. Some of the common non-surgical approaches are: 

• Pelvic Floor Exercises: Strengthening the pelvic floor muscles through Kegel exercises can offer additional support to the pelvic organs. A physical therapist can provide guidance on the proper techniques for Kegel exercises. 
• Pessary: Pessary is a device that is inserted into the vagina to offer structural support to the pelvic organs and relieve symptoms of pelvic organ prolapse. There are several types of pessaries, and the choice depends upon the type and severity of prolapse. 
• Lifestyle Modifications: Certain lifestyle modifications like weight management, avoiding heavy lifting, and dietary changes can help alleviate symptoms of prolapse. 
• Pelvic Floor Physical Therapy: Specialized therapy for the pelvic floor, including exercises, biofeedback, and manual techniques can help improve muscle tone and enhance overall pelvic floor function.

It’s important to mention that the effectiveness of non-surgical treatments varies for everyone. In most cases, several approaches must be done in conjunction to reduce symptoms. 

Get Help with Dr. Mozhgan 

If you’re struggling with pelvic organ prolapse and non-surgical treatments aren’t effective, consider meeting Dr. Mozhgan. She is one of the best gynecologists in Dubai with over 25 years of experience. Dr. Mozhgan will guide you to the proper care and help restore your quality of life.

Book an appointment and take control of your health!