How is pelvic organ prolapse treated?

Robotic surgery and traditional surgery can both be used for pelvic organ prolapse. Traditional surgery typically is either done vaginally without a mesh or through a larger incision with mesh.

With traditional vaginal surgery, while minimally invasive and successful, recurrence rates may be higher and initially there may be more discomfort. This is because with traditional surgery surgeons are tightening/repairing the woman’s tissue with her own tissue.

With the traditional open procedure, a sacrocolpopexy, an incision like a caesarean section is made and a piece of mesh is attached to the front and back wall of the vagina and then to a ligament on the spine. While this is arguably the most successful treatment it can have more pain, a slower recovery and perhaps bigger complications when they do occur.

Robotic surgery has many of the advantages of the traditional open sacrocolpopexy, without the long recovery, larger incision, and with much less pain.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

Learn about treatment options for pelvic prolapse in this video with Dr. Oz, Dr. Elizabeth Mueller, Dr. MaryPat Fitzgerald and Dr. Kimberly Kenton.

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. A mesh may be used if necessary to keep the organ in place. 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.

Pelvic organ prolapse is a condition in which uterine, bladder, urethral or rectal tissue protrudes into the vagina. Some women with pelvic organ prolapse use a pessary, a device similar to a diaphragm that's inserted in the vagina, to help support the pelvic area. Surgery to repair the ligaments of the pelvic floor is an increasing option. For postmenopausal women, hysterectomy is a common approach.

Dr. Kevin W. Windom, MD
OBGYN (Obstetrician & Gynecologist)

Pelvic organ prolapse (POP) can be treated in numerous ways. If a patient has mild pelvic organ prolapse (POP), then this could be treated with Kegel exercises or the use of a pessary. A pessary is a rubber device that comes in numerous shapes and sizes and it is placed in the vagina to help hold the bladder, the uterus and/or the rectum in place. When I see patients in the office who need a pessary placement, they are examined and then depending on what organ is prolapsing the most, I will place a pessary in the vagina to specifically fix that problem.

Other treatments for pelvic organ prolapse (POP) include surgical procedures. 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.

Surgery is not always necessary for pelvic organ prolapse; the condition affects quality of life but does not put you at risk of death or serious illness. If your healthcare provider diagnoses you with pelvic organ prolapse and says you need surgery, you should ask for more details about your condition and options. The need for surgery varies by individual: It depends on your level of activity, your level of discomfort and your goals for the treatment.

Dr. Angela T. Valle, MD
OBGYN (Obstetrician & Gynecologist)

With prolapse, the uterus and/or vagina protrudes into the vaginal canal and, in severe cases, can even be seen externally. You can have symptoms even when it's not this severe, so it’s important to have it evaluated. There are nonsurgical and surgical options. A nonsurgical option is a pessary, which is a plastic apparatus. It comes in different shapes and sizes and is fitted to your pelvis to help elevate whatever is prolapsing out. The device needs to stay in as long as you want relief from your symptoms.

Surgery is the other option, and there are various types of surgery depending on how severe your prolapse is. You will likely be referred to a urogynecologist who specializes in surgery for pelvic organ prolapse.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.