Pelvic organ prolapse, a condition affecting women, occurs when pelvic organs such as the bladder, uterus, or rectum shift from their normal positions and descends into the vaginal canal. Though mild-to-moderate cases of pelvic prolapse cases are asymptomatic, severe cases can lead to discomfort and functional challenges. 

Pelvic organ prolapse is typically managed by lifestyle modifications and non-surgical approaches such as pelvic exercises and pessaries. However, in cases of severe prolapse, doctors may opt for surgical interventions. This article aims to explore pelvic organ prolapse treatments, encompassing a range of solutions aimed at restoring pelvic health and enhancing the quality of life.

Understanding Pelvic Organ Prolapse

Vaginal prolapse types differ depending on the specific pelvic organ and tissues that are affected and are categorized as:

• Cystocele (Bladder Prolapse): A condition where the bladder drops down into the vagina.
• Rectocele: A condition where the rectum bulges into the vagina.
• Uterine prolapse: A condition where the uterus drops down the vaginal canal.
• Vaginal Vault Prolapse: This happens when the upper part of the vagina (cervix) drops into the vaginal canal.

Causes and risk factors:

Pelvic organ prolapse occurs when the body goes through stresses such as pregnancy and childbirth. The risk of the condition increases if there is multiple childbirth (especially if the baby is on the larger side), vaginal delivery, late first pregnancy, aging, obesity, history of pelvic surgery, chronic constipation and cough, and weak pelvic floor muscles.

Symptoms and impact on women's health

Symptoms of pelvic organ prolapse include pressure, pain and discomfort in the pelvic region, lower back pain, difficulty in urination and bowel movements, urinary incontinence, and discomfort during intercourse. This condition can disrupt daily activities and quality of life for women, thus making immediate and effective treatment necessary. It is also important to note that this condition will not go away on its own. Leaving it alone without treatment intervention will most likely cause the condition to worsen over time.

Non-Surgical Treatments for Pelvic Organ Prolapse

• Pelvic floor exercises for prolapse, i.e., Kegel exercises, are probably the most commonly advised non-surgical options for Pelvic Organ Prolapse. It involves contracting and relieving the pelvic floor muscles intermittently to help strengthen the muscle tone and pelvic support.
• Doctors also advise using pessaries to help provide the required support to the pelvic organs. Pessaries are small silicon devices that are inserted into the vagina. They lift the pelvic organs are prevents them from descending into the vaginal canal.
• Hormone therapy can also aid in maintaining vaginal tissue health and, thus, helps mitigate pelvic organ prolapse effects during menopause.
• Pelvic supports and braces can be purchased to provide stability to the prolapse. FemiCushion is a unique prolapse support device that uses a silicone cushion placed against the vaginal opening to support the prolapse and prevent it from bulging out of the body. This eliminates painful prolapse symptoms allowing women to return to their daily lives.
• Maintaining a healthy weight, staying physically active, and avoiding heavy lifting are also helpful in managing pelvic organ prolapse symptoms and improving quality of life.

Indications for Pelvic Organ Prolapse Surgery

Healthcare providers typically advise pelvic organ prolapse surgery for complex prolapse cases where symptoms severely affect the quality of life, or if non-surgical approaches could not provide adequate relief. It is recommended to look into more conservative treatment methods first as surgery for pelvic organ prolapse has risks of complication and side effects.

Surgical Approaches for Pelvic Organ Prolapse

There are various surgical approaches available for treating pelvic organ prolapse. It is important to discuss the surgical approach and method with your surgeon beforehand. Some of the possible surgeries to treat pelvic organ prolapse are listed below.  

Vaginal hysterectomy: This surgery involves the removal of the uterus through the vagina to treat uterine prolapse. This surgery should only be done if you do not wish to have more children in the future as it would not be possible to get pregnant after a hysterectomy. Studies also shows that a hysterectomy may increase the chances of bladder prolapse since the support structure of the uterus has been removed leaving the bladder for susceptible to falling as well.

Laparoscopic (Keyhole) hysterectomy is a minimally invasive variant of hysterectomy where the uterus is removed surgically through small incisions in the abdomen using a laparoscope. A Laparoscope is a tube like instrument that has a light source and camera allowing surgeons to access inside of the body without making a big incision.

Colpocleisis: It is a procedure typically recommended for older women treating vaginal vault prolapse. This surgery involves sewing together the vaginal wall and closing off the vaginal. This option is recommended for women who aren’t sexually active or do not have plans to conceive in the future. 

Sacrocolpopexy: This procedure uses surgical mesh to reinforce and support the pelvic organ after its position has been corrected. Mesh has been a controversial topic in prolapse surgeries. In 2011, the FDA issued a statement that banned use of surgical mesh in transvaginal repair of pelvic organ prolapse due to safety and effectiveness complications. 

Anterior Colporrhaphy: This surgical procedure is a frequently performed method for treating cystocele, during which the surgeon creates an opening in the anterior vaginal wall. They then adjust and secure the tissues to provide proper support for the bladder, effectively addressing the prolapse. Any surplus tissue is eliminated before suturing the vaginal wall to complete the procedure.

Paravaginal Repair: This method is used to treat considerable prolapse of the anterior vaginal wall resulting from weaknesses in the lateral supportive tissues of the vagina. During this surgery, the surgeon concentrates on restoring the bladder's lateral supports. Incisions are crafted in the vaginal wall, and the bladder is affixed to the pelvic sidewalls to rectify the displaced bladder's placement and provide extra reinforcement, reducing the likelihood of prolapse in the future.

Pelvic Organ Prolapse Surgery and Childbirth

The stresses of labor and childbirth can weaken the pelvic floor muscles and other connective tissues. Sometimes, the pelvic organs shift from the original position due to a lack of support and slip through the vaginal canal. In some severe cases, the prolapsed organ may protrude from the vagina. Multiple childbirths, pregnancy at a later age, giving birth to a large baby, etc, are also factors that can contribute to a higher risk for pelvic organ prolapse.

Postpartum management for pelvic organ prolapse focuses on strengthening pelvic floor muscles through exercises like Kegels. Lifestyle modifications, including weight management and proper lifting techniques to help prevent further strain. Using a proper well fitted pessary and pelvic support braces like FemiCushion can also help alleviate the symptoms. For severe cases, doctors may opt for surgical interventions.

Minimally Invasive Pelvic Organ Prolapse Surgery

Minimally invasive pelvic surgery involves laparoscopic or robotic surgeries. These techniques allow the surgeons to make small incisions through which specialized surgical instruments are inserted through to view the internal organs and perform essential procedure to secure the prolapsed organ in its proper position. These procedures allow for minimal scarring, better aesthetics, and shorter recovery time.

Recovery and Aftercare

Typically a brief brief hospital stay is recommended after prolapse surgery. You must also follow medical instructions closely including wound care and medication administration to promote optimal healing. Your doctor will also prescribe pain medications. However, if your pain persists or worsens, you must notify your doctor immediately as it can be a sign of infection.

Resuming daily activities and exercise will take some time after the surgery. Your doctor will provide a timeline to guide you to gradually resume your daily activities. You will be advised to start light exercises initially and avoid heavy lifting.

Potential Complications and Risks

During pelvic organ prolapse surgery, you may encounter common risks such as infection, bleeding, and anesthesia-related complications. To prevent these, your healthcare provider will ensure meticulous surgical planning and employ strict aseptic techniques. Regular postoperative follow-up appointments also help in the timely detection and management of any possible complications.

Long-Term Outcomes and Success Rates

Surgery to treat pelvic organ prolapse works well for many patients, however results from surgery is not always permanent. Its success depends on important factors like the patient's overall health, age, and medical history, as well as careful planning before the surgery and the way the surgery is done.  

Following the post-surgery instructions and guidelines has a big impact on how well you do in the long run. Also, having a skilled and experienced surgeon increases the likelihood of getting good results.

Conclusion

While not life-threatening, pelvic organ prolapse can significantly impact one's quality of life. Therefore, it is important to seek timely treatment. Doctors usually advise non-surgical approaches such as lifestyle modifications, pelvic floor exercises, and pessaries. Surgical interventions may be needed in severe cases. There are different surgical options available, like vaginal and laparoscopic hysterectomy, colpocleisis, and sacrocolpopexy etc. We recommend consulting your doctor to better understand the risks and benefits before making a decision.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.