What is pelvic organ prolapse?

Pelvic organ prolapse is when one or more of the pelvic organs drop from their normal position. Prolapse can involve the uterus or the vaginal vault for women who have had a hysterectomy, the front wall of the vagina or the bladder (cystocele) and the back wall of the vagina or the rectum (rectocele) as well as the pouch between the rectum and the back wall of the uterus involving the small intestine (enterocele).

What are the symptoms of pelvic organ prolapse?

In severe prolapse, the woman can see or feel a bulge of tissue at or past the vaginal opening. Most women have mild prolapse and may experience a feeling of fullness or heaviness in the pelvis, painful or uncomfortable sex, difficulty urinating or passing bowel movements.

How is pelvic organ prolapse treated?

If you do not have any symptoms or if your symptoms are mild, you do not need any special follow-up or treatment beyond having regular checkups. If you have symptoms, prolapse may be treated with or without surgery.

What are the nonsurgical treatments for pelvic organ prolapse?

Often the first nonsurgical option tried is a pessary. This device is inserted into the vagina to support the pelvic organs. Targeting specific symptoms may be another option. Kegel exercises may be recommended in addition to symptom-related treatment to help strengthen the pelvic floor. Weight loss can decrease pressure in the abdomen and help improve overall health.

When should I consider surgery to treat pelvic organ prolapse?

If your symptoms are severe and disrupt your life, and if nonsurgical treatment options have not helped, you may want to consider surgery.

What are the types of surgery for pelvic organ prolapse?

In general, there are two types of surgery; obliterative surgery and reconstructive surgery.

Obliterative surgery narrows or closes off the vagina to provide support for prolapsed organs. Sexual intercourse is not possible after this procedure.

Reconstructive surgery reconstructs the pelvic floor with the goal of restoring the organs to their original position. Some types of reconstructive surgery are done through an incision in the vagina. Others are done through an incision in the abdomen or with laparoscopy.

What are the types of reconstructive surgery?

Fixation or suspension using your own tissues (uterosacral ligament suspension and sacrospinous fixation)—These procedures are performed through the vagina and may involve less recovery time than those performed through the abdomen. A procedure to prevent urinary incontinence may be done at the same time.

Anterior and posterior colporrhaphy—Because these procedures are performed through the vagina, recovery time usually is shorter than with procedures performed through the abdomen.

Sacrocolpopexy and sacrohysteropexy—These abdominal procedures may result in less pain during sex than procedures performed through the vagina.

Surgery using vaginally placed mesh—Mesh placed through the vagina has a significant risk of complications, including mesh erosion, pain, and infection. Because of these risks, vaginally placed mesh for pelvic organ prolapse usually is reserved for women in whom previous surgery has not worked, who have a medical condition that makes abdominal surgery risky, or whose own tissues are too weak to repair without mesh.

What is involved in recovery after surgery to treat pelvic organ prolapse?

Recovery time varies depending on the type of surgery. You usually need to take a few weeks off from work. For the first few weeks, you should avoid vigorous exercise, lifting, and straining. You also should avoid sexual intercourse for several weeks after surgery.