Should I have surgery for pelvic organ prolapse?
Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
Many women will have some kind of pelvic organ prolapse as they get older. Pelvic organ prolapse is a long-lasting condition. You may be able to relieve some symptoms with special exercises, a device called a pessary, or by making changes to your lifestyle. Your decision about surgery for pelvic organ prolapse may depend on how bad your symptoms are and how much they affect your quality of life.
Consider the following when making your decision:
- Many women have only mild symptoms of pelvic organ prolapse. Surgery is usually only done when the prolapse affects your daily life and your doctor thinks surgery will help.
- Many kinds of surgery can be done for pelvic organ prolapse. The type of surgery you have will depend on which organs have prolapsed.
- Consider surgery if the prolapse is causing pain, if you are having problems with your bladder and bowels, or if the prolapse is making it hard for you to do activities you enjoy.
- An organ can prolapse again after surgery. Surgery in one part of your pelvis can make a prolapse in another part worse. This may mean that you have to have another surgery later.
- You might be able to relieve some symptoms on your own without surgery. You can do exercises at home that make your pelvic muscles stronger.
- If you choose, your doctor can fit you with a device called a pessary. A pessary can help you cope with pelvic organ prolapse. It's a removable device that fits in your vagina and holds your pelvic organs in place.
Medical Information
What is pelvic organ prolapse?
Pelvic organ prolapse occurs when a pelvic organ, such as your bladder, drops (prolapses) from its normal spot in your lower belly and pushes against the sides of your vagina. This can happen when the muscles that hold your pelvic organs in place get weak or stretched from childbirth or surgery.
The most common organ prolapse involves the bladder
.
More than one pelvic organ can prolapse at the same time. Other organs that can be involved when you have pelvic prolapse include your:
Symptoms of pelvic organ prolapse can depend on the organs involved. But the most common symptoms include:
- Feeling pressure from pelvic organs pressing against the sides of your vagina.
- Feeling very full in your lower belly.
- Feeling as if something is falling out of your vagina or feeling something in your vagina when you wipe after using the bathroom.
- Feeling a pull or stretch in your groin area or pain in your lower back.
- Releasing urine without meaning to (incontinence), or needing to urinate a lot.
- Having pain during sex.
- Having problems with your bladder or bowels, such as constipation or problems emptying your bladder.
Many women with pelvic organ prolapse have only mild symptoms. Surgery is usually only done when the prolapse is affecting your daily life and your doctor thinks surgery will help. Consider surgery if:
- The prolapse causes pain.
- You have problems with your bladder and bowels.
- The prolapse makes it hard for you to do activities you enjoy.
What kinds of surgery are done for pelvic organ prolapse?
Many kinds of surgery can be done for pelvic organ prolapse. The type of surgery you have will depend on which organs are prolapsed.
Types of surgery include:
- Repair of the vaginal wall (vaginal vault prolapse surgery).
- Repair of the bladder (cystocele surgery) or urethra (urethrocele surgery).
- Repair of the rectum (rectocele surgery) or small bowel (enterocele surgery).
- Surgery to close the vagina (vaginal obliteration). This surgery is only an option if you no longer want to have sex.
- Removal of the uterus (hysterectomy).
During surgery for bladder, urethra, rectum, and small bowel prolapse, the surgeon makes a cut, called an incision, in the wall of the vagina. He or she pulls together the loose or torn tissue in the area of the prolapsed organ and strengthens the wall of the vagina to keep the prolapse from coming back.
During surgery for vaginal vault prolapse, the surgeon makes an incision in the wall of the vagina. He or she attaches the top of the vagina to the wall of the lower belly, to the spine in the lower back, or to the ligaments of the pelvis.
During a hysterectomy, the surgeon removes the uterus. During a vaginal obliteration, the surgeon removes most of the vaginal lining and then sews the vagina shut. If the uterus is still present, a small opening is left to allow fluid to drain from the uterus.
These surgeries are usually performed by a gynecologist or a urologist. You will have medicine to make you sleepy during the surgery (anesthesia). You may stay in the hospital for a day or two. You may go home with a catheter, a flexible plastic tube that drains urine from your bladder when you can't urinate by yourself.
After surgery, you will likely be able to return to your normal activities in about 6 weeks.
For the first 3 months after surgery, you will need to take it easy and avoid heavy lifting or long periods of standing. Your prolapse can return if you strain or lift too soon after surgery.
It may be best to delay surgery if you plan to have children. The strain of childbirth could cause your problem to come back.
What are the risks of surgery for pelvic organ prolapse?
Problems you may have after surgery can include:
- Incontinence.
- Not being able to empty your bladder.
- Pain during sex.
- Infection.
- Bladder injury.
- A hole or opening that forms between two organs in your body, or between your body and your skin. This is called a fistula.
Since surgery for pelvic organ prolapse is done to treat symptoms caused by one prolapsed organ, you may still have other symptoms after your surgery. Surgery in one part of your pelvis can make a prolapse in another part worse. This may mean that you have to have another surgery later.
Pelvic organ prolapse can come back after surgery. How well surgery works depends on the type of surgery. But on average, about 3 out of 10 women who have the surgery end up having a second surgery within 4 years.1, 2
The chances for success can be higher when a woman has two surgical procedures during the same operation—one to correct the prolapse and the other to help prevent incontinence problems that can arise after surgery. But more research is needed to find out if this is true for all types of prolapse surgeries.3
What are my other choices besides surgery?
You may be able to relieve some symptoms of pelvic organ prolapse on your own. Try special exercises, called Kegels, that make your pelvic muscles stronger. Cut back on caffeine, which acts as a diuretic and can make you urinate more often. Eat foods that are high in fibre to avoid constipation and straining when you have a bowel movement. Reach and stay at a healthy weight. More weight puts pressure on your pelvic muscles. And avoid lifting heavy things that put stress on your pelvic muscles.
If you choose, your doctor can have you fitted with a device called a pessary
If you need more information, see the topic Pelvic Organ Prolapse.
Your Information
Your choices are:
- Have surgery for pelvic organ prolapse.
- Don't have surgery for pelvic organ prolapse.
The decision whether to have surgery for pelvic organ prolapse takes into account your personal feelings and the medical facts.
Deciding about surgery for pelvic organ prolapse Reasons to have surgery for pelvic organ prolapse
Reasons to not have surgery for pelvic organ prolapse
- The prolapsed organ is causing a lot of pain.
- You are having problems with your bladder and bowels.
- The prolapse is making it hard for you to do activities you enjoy.
- Your symptoms are affecting your quality of life.
- You would rather have surgery than try to manage symptoms on your own.
Are there other reasons you might want to have surgery?
- Your symptoms are mild and don't get in the way of daily activities.
- You would like to try exercise to make your pelvic muscles stronger.
- You want to avoid surgery if at all possible.
- You do not have time to undergo and recover from surgery.
- You are able to manage your symptoms on your own or with a pessary.
Are there other reasons you might not want to have surgery?
These personal stories may help you make your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about surgery for pelvic organ prolapse. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
I don't have any symptoms, or they are very mild. Yes No Unsure The quality of my daily life is affected by this condition. Yes No Unsure I want to avoid surgery no matter what. Yes No Unsure I'd like to try other ways to deal with my symptoms besides having surgery. Yes No Unsure I'm tired of trying to manage my symptoms on my own. Yes No Unsure My symptoms are painful and embarrassing. I can't live with them. Yes No NA* I'm worried about the time it takes to recover from surgery.
Yes No NA My condition makes it hard for me to enjoy sex. Yes No NA *NA=Not applicable
Use the following space to list any other important concerns you have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not to have surgery for pelvic organ prolapse.
Check the box below that represents your overall impression about your decision.
Leaning toward having surgery for pelvic organ prolapse
Leaning toward NOT having surgery for pelvic organ prolapse
Return to the topic Pelvic Organ Prolapse.
| Author: | Carrie Henley Monica Rhodes | Last Updated: November 29, 2007 |
| Medical Review: | Adam Husney, MD - Family Medicine Joy Melnikow, MD, MPH - Family Medicine R. Hugh Gorwill, MD - Obstetrics and Gynecology | |
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