In severe cases of pelvic organ prolapse where other treatment methods have not alleviated the symptoms, surgery may be the treatment of choice. During this type of surgery, a surgeon repairs the weakened or damaged portion of the pelvic muscles and connective tissue and pushes the protruding organ back into place. In some cases the upper part of the vagina is surgically attached to a nearby bone for support. The surgeon may also make repairs to resolve urinary or bowel incontinence if that is an issue. The operation may be done through the vagina or an incision may be made in the abdominal wall. Because of the structures involved, surgery is usually only performed on women who are not planning to have more children.
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If you have pain and discomfort from pelvic organ prolapse that does not respond to nonsurgical treatment and lifestyle changes, you may want to consider surgery. The choice of surgery depends upon which organs are involved, how bad your symptoms are and what other medical conditions are present. Also, your surgeon may have experience with and preference for a certain procedure. The goals of surgery are to relieve your symptoms and restore the normal functioning of your pelvic organs.
There are several types of surgery to correct stress urinary incontinence. These can be done at the same time as surgery to repair prolapse. These surgeries lift the urethra and/or bladder into their normal position.
Surgery choices: Surgical procedures used to correct different types of pelvic organ prolapse include:
- Repair of the prolapsed bladder (cystocele) or urethra (urethrocele).
- Removal of the uterus (hysterectomy).
- Repair of the rectum (rectocele) and small bowel (enterocele).
- Repair of the vaginal wall (vaginal vault suspension).
- Closure of the vagina (vaginal obliteration).
What to think about: Surgeries are designed to treat specific symptoms, so you may still have other symptoms after surgery. An examination while you have a pessary in your vagina may help the doctor see if urinary incontinence would be a problem after surgery. If the exam shows that urinary incontinence will be a problem, another surgery can be done at the same time to fix the problem.
Surgery in one part of your pelvis can make a prolapse in another part worse, possibly requiring separate treatment in the future.
Pelvic organ prolapse is strongly linked to labor and vaginal delivery. So you may want to delay surgery if you plan to have children.
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Kevin Windom, MD, Obstetrics & Gynecology, answered
There are numerous surgeries for pelvic organ prolapse (POP). The most common surgery is an anterior and posterior repair. This is a procedure where the connective tissue is "bustled up" to help remedy the bulging of the bladder or the rectum into the vagina. In my opinion this is a poor procedure and it carries a high failure rate. I believe that the best treatment for pelvic organ prolapse (POP) is repairing the hernia or connective tissue defect and reinforcing this with some type of synthetic or biologic mesh. These surgeries can be performed abdominally, vaginally, or laparoscopically. It is important to talk to your doctor about his or her way of treating these problems and if you are not satisfied then seek a second opinion from someone who specializes in this type of surgery - a urogynecologist.