Pelvic Organ Prolapse Surgery

The pelvic floor can be regarded as a layer of muscles, tissues, and nerves that “holds” a group of organs in place: the urinary bladder, uterus, vagina (the internal portion of the genitalia) and more. It also helps with continence and even contributes to proper body posture.

Various factors could lead to the weakening of the pelvic floor, mainly weakening of the muscles of the region, which could lead to downwards prolapse of those organs. While this can occur in men and in women, it is more characteristic of women, mainly due to their anatomy: prolapse of the pelvic floor will lead to prolapse of various organs down towards the vaginal opening (vulva), which does not occur in men, obviously, and can cause discomfort and pain. In the most severe cases, pelvic organ prolapse surgery would even be needed to treat the problem.

Severe prolapse of the pelvic floor can impair the function of the urinary bladder and the function of the bowel, cause a sensation of urinary urgency, a sensation of pressure in the entire pelvic area, pain, discomfort during sexual intercourse and more.

There are many factors that promote the prolapse of the pelvic floor, but the direct cause is not yet known. Difficult delivery or many deliveries accelerate the process in some women, as does age of course – the older the woman, the more flaccid her bodily muscles become, including those of the pelvic floor.

Gynecological surgery, obesity, and genetics are considered to be additional factors that promote the occurrence of the problem.

General information about pelvic organ prolapse surgery

The vaginal vault prolapse floor does not automatically necessitate surgery. If the problem is in its early stages, conservative treatment will usually be sufficient – mainly exercises to strengthen the pelvic floor, a concept familiar to many women. An additional conservative treatment is the insertion of a certain device, whose shape resembles that of a diaphragm (a longstanding method of contraception), into the vagina, preventing pelvic organs from prolapsing out.

Surgery will be the preferred option if the pelvic floor prolapse is at an advanced stage, causing much pain and marked discomfort. The selection of the type of operation depends on many factors, such as the woman’s age, her desire to give birth in the future and the like. Thus, for instance, the medical team may sometimes decide that hysterectomy will help improve the condition, but such an operation would usually only be done in older women who are beyond childbearing age.

Preparing for the procedure

Preparation for the operation depends on the method by which it will be performed. If it is performed under general anesthesia, you will be asked to fast for a few hours before the operation. A few days prior to or shortly before the operation, you will probably undergo various imaging tests, which will provide the physicians with a clear picture regarding the current status of the pelvic floor.

The course of the procedure

Pelvic organ prolapse surgery may be performed by three methods:

• Abdominal approach: This is currently the most common approach, during which the surgical procedure will be performed via the lower abdomen. This operation may be done by open approach or by minimally invasive approach, in the course of which the pelvic muscles are strengthened or a special type of mesh is inserted, which will provide the required support
• Vaginal approach: An operation that is performed via the vagina, in which the pelvic floor muscles are strengthened by juxtaposing them to pelvic connective tissue (ligaments), thus stretching and strengthening the entire pelvic floor. The same special mesh for supporting the pelvic floor can also be inserted by this surgical approach.
• Surgery to close the vagina: This operation is usually only done in older women. It will prevent pelvic organ prolapse, but also will not enable sexual intercourse. The operation is done in a way that will not impair the function of the urinary bladder or of the rectum.

This surgery can be performed under local anesthesia (mainly in operations by vaginal approach) or general anesthesia. It usually takes approximately an hour. Recovery is not particularly long: if you undergo an operation by a minimally invasive or vaginal approach, you will already be released to your home after about two days. An operation by an open approach will require longer hospitalization.

The time that elapses until full recovery may be approximately three months, at the beginning of which you will be asked to avoid strenuous activity. You will be able to gradually resume full activity, including lifting heavy weights and engaging in sexual intercourse.

Side Effects

This procedure is not associated with many side effects. The most common effects are surgical infection, which is considered to be quite rare, and vaginal bleeding, which passes after a few days. There is a chance of difficulty occurring in urinating and in emptying the bowel after the operation, but these too are not common. If a mesh to support the pelvic floor is inserted during the operation, swelling may develop in the region, which could cause pain during sexual intercourse for a certain period.