Introduction

Pelvic Organ Prolapse (POP) is an illness in which one or more pelvic organs like the bladder, uterus or rectum, fall from their normal positions and press against the wall in the vagina. This can cause pain and bowel or urinary problems and can affect women’s daily routine. It is good news that India is now a renowned destination for effective and affordable pelvic organ prolapse surgeries, offering modern treatment options with experienced Gynecologic surgeons.

What is Pelvic Organ Prolapse Surgery?

Pelvic Organ Prolapse Surgery is performed to restore and relocate to reposition the organ(s) that have prolapsed. organ(s). The aim is to bring back the normal pelvic floor’s anatomy and to improve the quality of life for patients.

Common POP surgery include:

Hysterectomy (removal of the uterus) often done when the uterus is prolapsed.
sacral colpopexy a minimally invasive surgical procedure where mesh is utilized to help support pelvic organs.
A posterior or anterior repair (Colporrhaphy) to treat rectal prolapse or bladder problems.
Vaginal Vault Suspension this is done after it appears that top part of vagina is prolapsed.

What is the person who Needs This Surgery?

Pelvic Organ Prolapse Surgery is generally recommended when:

Non-surgical treatment options like pessaries or pelvic floor exercises don’t work.
The prolapse can impact everyday activities like the urinate, walking or intercourse.
The patient may experience is moderate to extreme discomfort and/or tension in the pelvic region.
Other signs such as constipation or urinary incontinence are common.

Surgical Procedure

1. Preoperative Assessment :- Before undergoing Pelvic Organ Prolapse surgery, a thorough evaluation is essential to determine the extent of the prolapse and ensure the patient is fit for the procedure. This includes:

Pelvic Examination :- A physical examination is performed to assess which organs have prolapsed and to what degree. The doctor examines the vaginal walls, uterus, bladder, and rectum to identify prolapse severity and plan the appropriate surgical repair.
Urinary Tests :- These tests help detect urinary incontinence or infections. A urine culture or urinalysis may be ordered to rule out bladder infections. Urodynamic tests might also be used to check how well the bladder and urethra are working, especially if the patient has urine leakage.
Imaging (Ultrasound/MRI) :- Diagnostic imaging provides a clearer view of the pelvic anatomy. A pelvic ultrasound may be used initially, while an MRI is reserved for complex cases or when detailed soft-tissue visualization is necessary. These tools help guide the surgical strategy.

2. Anesthesia :- Depending on the patient’s medical condition, age, and the type of surgery being performed, either of the following anesthesia methods is used:

General Anesthesia :- The patient is completely unconscious throughout the surgery. This method is preferred in cases of abdominal or laparoscopic surgeries, or when multiple organs are involved.
Spinal or Regional Anesthesia :- In some vaginal surgeries, spinal anesthesia may be used, where the lower half of the body is numbed. The patient remains awake but feels no pain in the surgical area. It has a quicker recovery time and fewer risks for some patients.

3. Surgical Method :- Pelvic Organ Prolapse surgery can be approached in different ways depending on the severity and location of the prolapse:

Vaginal Approach :- This method involves accessing the prolapsed organs through the vagina without external incisions. It’s less invasive and has a faster recovery. Ideal for elderly or high-risk patients.
Abdominal Approach :- A traditional open surgery that involves making an incision in the abdomen to access the pelvic organs. Used in cases where extensive repair or abdominal support structures are involved.
Laparoscopic/Robotic-Assisted Approach :- Minimally invasive techniques using small incisions and a camera. These procedures offer better precision, reduced bleeding, and faster healing. Robotic surgery provides superior 3D visualization and more accurate suturing.
Surgical Correction :- Once inside, the prolapsed organ is gently moved back to its correct anatomical position. The surgeon may uses sutures to hold the organ in place. Synthetic mesh (in some cases) to provide additional support, particularly for severe or recurrent prolapse.

4. Hysterectomy :- If the uterus is prolapsed, the surgeon may recommend a hysterectomy, which involves the removal of the uterus. This can be done through:

Vaginal hysterectomy (preferred for prolapse cases),
Laparoscopic hysterectomy, or
Abdominal hysterectomy depending on the complexity.

This step is often included to prevent future prolapse and eliminate symptoms such as bleeding or pressure caused by the uterus pressing on the vaginal walls.

5. Repair and Reinforcement of the Pelvic Floor

In many cases, pelvic floor muscles and ligaments are weakened and need reinforcement. The surgeon may:

Tighten stretched or torn ligaments.
Suture loose tissues (fascia).
Reconstruct the vaginal walls to provide durable structural support.
Repair may include anterior repair (for bladder prolapse) or posterior repair (for rectal prolapse).

In cases of vaginal vault prolapse (after hysterectomy), procedures like sacrocolpopexy (attaching the vaginal vault to the sacrum) may be used for support.

6. Closure and Postoperative Monitoring :- Once the necessary corrections are made:

The surgical area is carefully closed using absorbable sutures.
Any incisions (if external) are closed and dressed.
The patient is moved to the recovery room where vital signs are closely monitored as the anesthesia wears off.

Post-surgery, the patient may have a catheter placed temporarily to aid urination and prevent bladder stress.

Rehabilitation After Surgery

1. Hospitalization (2 to 3 Days) :- After surgery, the patient remains in the hospital for observation and pain management. During this time:

IV fluids and antibiotics may be given.
The bladder and bowel function is monitored.
Early ambulation (walking) is encouraged to prevent blood clots.

2. Rest Period (Up to 6 Weeks) :- The complete recovery period is about 6 weeks, although some may feel well earlier. Rest is critical to allow tissues to heal and prevent recurrence.

During this time:

Follow-up appointments are scheduled.
A gradual return to normal activities is advised.
The patient is educated on pelvic health practices to ensure long-term success.

3. Activities to Avoid :- To ensure proper healing and prevent stress on the surgical site, the following activities must be avoided for at least 6 weeks:

Heavy Lifting :- Avoid lifting anything heavier than 5–10 pounds, including children or grocery bags.
Straining During Bowel Movements :- Constipation should be prevented using a high-fiber diet, hydration, and mild stool softeners.
Sexual Intercourse :- Sexual activity should be completely avoided until the doctor confirms complete healing, generally after 6 weeks. Early intercourse may cause discomfort or disrupt surgical repairs.

4. Follow-Up Care :- Postoperative care is a crucial component of long-term success. Follow-up visits typically include:

Pelvic Examination :- To ensure organs are staying in place and there are no signs of infection or complications.
Discussion of Symptoms :- Any discomfort, bleeding, or urinary/bowel issues should be reported.
Pelvic Floor Therapy :- Patients may be referred for physiotherapy to strengthen the pelvic muscles and reduce recurrence risk.
Monitoring for Mesh Reactions (if used) :- Rarely, complications from surgical mesh can occur and need evaluation.

Conclusion

Pelvic Organ Prolapse Surgery in India offers patients with this condition a secure, efficient and cost-effective treatment option. With the help of experts and the most modern equipment patients can expect faster recovery and lasting relief. If you’re experiencing symptoms of prolapse, do not hesitate to seek out a gynecologist to consider the appropriate surgical procedure for you.