Treatments for Pelvic Organ Prolapse
There are a variety of therapies from which a woman can choose to treat pelvic organ prolapse and eliminate bothersome symptoms, including non-surgical and surgical options.
Pelvic organ prolapse is not life-threatening, which means that if you do not experience discomfort, you may simply monitor its progress over time. It may stay the same size. It could also worsen as the years pass.
Some lifestyle changes can help reduce symptoms of pelvic organ prolapse, including:
- Eliminating constipation
- Avoiding straining with bowel movements
- Losing weight
- Quitting smoking: Use of tobacco doubles the risk for pelvic floor disorders
Pelvic Floor Physical Therapy
Physical therapy of the pelvic floor is aimed at rehabilitating the pelvic floor muscles to restore their normal function. For the best results, you should work with a specialized physical therapist who will help you learn the most effective techniques. Some women need to improve their pelvic floor muscle function with strengthening exercises while others need stretching and relaxing exercises. Your physician will evaluate your pelvic floor muscles at your initial consultation and provide a referral if necessary.
- A pessary is a small device that is inserted into the vagina to support the pelvic organs and eliminate the bulge caused by pelvic organ prolapse. Pessaries are usually used temporarily to avoid surgery in women who have not completed their families or have medical problems that make surgery risky. If you are interested in trying a pessary, one of the Urogynecologists at the Women’s Integrated Pelvic Health Program can find one that works for you.
Surgery for Pelvic Organ Prolapse
Women with symptoms of pelvic organ prolapse may opt for surgical repair. These surgeries are performed by a Urogynecologist to improve the anatomy of the pelvic floor. There are several different types of surgery to treat pelvic organ prolapse. A woman may benefit more from one type of surgery than another based on her age, prior surgical history, severity of prolapse, and overall health. Your surgeon should be able to offer all of the following surgical options and help you determine which surgery is best for you.
These may include:
- Apical Suspensions: Prolapse of the top of the vagina is the most common type of prolapse, and apical suspension procedures restore support to the top of the vagina. They are sometimes performed at the same time as a hysterectomy, if you have a uterus. If you have already had a hysterectomy, then these procedures support the top of the vagina. Surgery to repair the top of the vagina is usually performed through minimally invasive techniques that do not require a large incision on the abdomen, including:
- Laparoscopic and robotic surgery (sacrocolpopexy): Several small 5-8 mm incisions are made on the abdomen, and the top of the vagina is attached to strong pelvic ligaments using a synthetic material or sutures. Patients can usually go home from the hospital on the day of surgery with minimal pain and recovery time.
- Vaginal surgery (uterosacral ligament suspension, sacrospinous ligament suspension): An incision is made in the vagina and stitches are used to attach the top of the vagina to strong ligaments in the pelvis. These surgeries are typically referred to as “native tissue repairs” as the woman’s own ligaments are utilized to repair the prolapse. Similar to laparoscopic and robotic procedures, patients usually go home from the hospital on the day of surgery with minimal pain or recovery time.
Some women with prolapse of the uterus prefer to not have a hysterectomy, and laparoscopic and robotic procedures can be done without removing the uterus (sacrohysteropexy).
- Anterior Vaginal Prolapse Repair: Uses an incision in the wall of the vagina underneath the bladder to place sutures to reinforce the scaffolding between the bladder and vagina.
- Posterior Vaginal Prolapse Repair: Uses an incision in the back wall or floor of the vagina over the rectum to help rebuild the wall between the vagina and the rectum.
- Vaginal Closure Procedure (Colpocleisis): This procedure is most appropriate for women who do not engage in vaginal intercourse and do not intend to have vaginal intercourse in the future. A colpocleisis shortens the vagina by sewing together the inside vaginal walls. It has the highest success rates and quickest recovery of all prolapse surgeries, so it can be a good option in women who would like a quicker surgery or are too ill to have reconstructive procedures.
Recovery After Surgery
Most women who have prolapse surgery performed laparoscopically, robotically, or vaginally will go home from the hospital on the day of surgery. You will be allowed to resume all your activities and exercise as soon as you feel up to it. Our team recently published research showing that women who are able to get back to their lifestyles had better surgical outcomes and quality of life than those whose activities were restricted after surgery.