Conservative treatment, (physical therapy, lifestyle modifications and pessaries) are the first line of treatment for prolapse, however in some cases, surgery is necessary. It’s important to know that there are options when it comes to surgery so you can ask questions and discuss what surgery makes the most sense for you with your surgeon. This is not meant to be an in-depth review, but rather an overview of types of surgery for prolapse.
This type of surgery uses fixation or suspension using your own tissues (“native tissue”). This is used to treat uterine or vaginal vault prolapse and performed through the vagina. The prolapsed part of the vaginal wall is attached with stitches to a ligament or a muscle in the pelvis. A procedure to prevent urinary incontinence may be done at the same time.
This type of surgery is used to treat prolapse of the front and back walls of the vagina performed through the vagina. Stitches are used to strengthen the vagina so it can once again support the bladder and/or rectum.
This surgery is used to treat vaginal vault prolapse and uterine prolapse. It can be done with an abdominal incision or with laparoscopy. Surgical mesh is attached to the front and back walls of the vagina and then to the sacrum to lift the vagina back in place.
Surgery using vaginally placed mesh is used to treat all kinds of prolapse. It is often used in women whose own tissues are not strong enough for native tissue repair. Per the American College of Obstetricians and Gynecologists “vaginally placed mesh has a significant risk of severe complications, including mesh erosion, pain, infection, bladder or bowel injury.“
Over 74,000 hysterectomies are performed each year with pelvic organ prolapse as the main indication for surgery, however it is not the recommended surgery for prolapse. In fact, women who undergo a hysterectomy are at a significant increased risk of pelvic organ prolapse. Having a preexisting pelvic floor issue prior to surgery is the single greatest risk factor for prolapse and is more common in women who have had multiple children and already have weakened pelvic floor muscles.
A recent review found that preserving the uterus when performing a POP surgery actually increased success rates and decreased the risk of having to have surgery again.
If surgery is right for you, it is important to prepare for the surgery as well as having guidance for recovery to insure the success of your surgery. If you undergo surgery to correct your prolapse, but don’t address the things that contributed to your prolapse in the first place (breath holding, weakness, constipation/poor toileting habits, etc), recovery could be delayed or the surgery could be less than successful. Being prepared for healing and recovery and guidance to get back to the activities you love will make your experience that much better.
“In August 2017, I had a hysterectomy and they removed everything but my ovaries. After 8 weeks recovery, I went back to work but was still in constant pain around lower abdomen and in pelvic area .After 8 months, I was referred to pelvic floor PT. I immediately saw results with the techniques she gave me to do. After 5 months, it felt so good to be pain free everyday! It was definitely the best experience I could do for myself to get complete healing from my hysterectomy and to protect my pelvic floor from any future issues.”
LINDA, CLIENT TESTIMONIAL
There are a lot of resources for women who need surgery and for those who have undergone surgery and may not be experiencing the best results:
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