Procedure of Pelvic Organ Prolapse

Pelvic Organ Prolapse (POP) is a condition that affects many women, especially after childbirth or menopause. It occurs when one or more of the pelvic organs such as the bladder, uterus, rectum, or small intestine descend from their normal position and press against the vaginal wall. This condition can significantly affect a woman’s quality of life, leading to symptoms like discomfort, urinary problems, or a feeling of fullness in the pelvic area. Fortunately, with advancements in medical technology, the procedure for treating pelvic organ prolapse has become safer and more effective.

Many women first notice the condition as a feeling of pressure or fullness in the pelvic region, particularly after standing for long periods or engaging in physical activity. Others may feel as though something is “falling out” of the vagina. Although common after childbirth, especially following multiple vaginal deliveries, POP can also develop after menopause due to the natural decline in estrogen, which weakens the pelvic tissues. Chronic straining from constipation, obesity, or persistent coughing can also increase the risk.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse happens when the muscles and tissues supporting the pelvic organs weaken, allowing these organs to drop or bulge into the vaginal canal. The most common types include

1. Cystocele (bladder prolapse)

2. Rectocele (rectum prolapse)

3. Uterine prolapse

4. Enterocele (small intestine prolapse)

5. Vaginal vault prolapse (after hysterectomy)

This condition is often caused by factors like multiple vaginal deliveries, aging, obesity, chronic coughing, heavy lifting, and genetic predisposition.

When Is Surgery Required for Pelvic Organ Prolapse?

While mild cases can be managed with pelvic floor exercises, lifestyle changes, or the use of a pessary, surgery is considered when symptoms become severe or significantly interfere with daily life. Women who experience frequent urinary incontinence, difficulty in bowel movements, vaginal pressure, or visible bulging from the vaginal opening are often candidates for surgical correction.

Types of Pelvic Organ Prolapse Surgery

There are several surgical approaches to treating POP, and the choice depends on the type and severity of prolapse, overall health, and whether the woman wishes to preserve sexual function or fertility.

1. Vaginal Approach :- This is the most common route for POP surgery. Surgeons operate through the vagina to lift and secure the prolapsed organs. It is less invasive and typically offers a faster recovery.
2. Abdominal Approach :- Performed either through a traditional open incision or laparoscopically (keyhole surgery), the abdominal approach involves lifting the pelvic organs using surgical mesh or sutures for reinforcement. Laparoscopic or robotic-assisted sacrocolpopexy is a commonly used technique under this category.
3. Obliterative Surgery :- This approach is best suited for elderly women who are no longer sexually active. It involves partially or completely closing off the vaginal canal to support the prolapsed organs. Though highly effective, this procedure prevents vaginal intercourse.

Preoperative Preparation

Before surgery, your doctor will conduct a series of evaluations, including a pelvic exam, urine tests, and sometimes imaging studies like ultrasound or MRI. You may also undergo urodynamic testing if urinary symptoms are present.

In the days leading up to the procedure, patients are usually advised to

1. Stop smoking and avoid alcohol

2. Discuss all medications with the doctor

3. Follow bowel preparation instructions, if given

4. Fast for a certain number of hours before surgery

A thorough understanding of the risks, benefits, and recovery expectations will also be discussed during the preoperative consultation.

Procedure of Pelvic Organ Prolapse

The surgery is typically performed under general or regional anesthesia and may take 1 to 3 hours depending on complexity.

1. Access and Exposure :- The surgeon first accesses the affected area via the vaginal or abdominal route. In vaginal surgeries, retractors are used to gently open the vaginal canal for a clear view.
2. Repositioning of Organs :- The prolapsed organ (e.g., bladder or uterus) is then repositioned to its correct anatomical location. In uterine prolapse, the uterus may be either lifted and secured (uterine-sparing surgery) or removed via hysterectomy if necessary.
3. Tissue Repair or Reinforcement :- Weakened tissues are tightened using sutures. In some cases, surgical mesh may be used to support and strengthen the area, especially in repeat or severe prolapse cases.
4. Closure :- Once the organs are securely in place, the surgeon closes the incisions. In laparoscopic or robotic-assisted surgeries, tiny incisions are closed using sutures or surgical glue, ensuring minimal scarring.

Postoperative Recovery

Recovery from pelvic organ prolapse surgery depends on the surgical approach used. Vaginal and minimally invasive surgeries generally offer quicker healing times compared to open abdominal surgery.

Most women can return home the same day or within 1–2 days post surgery. Common postoperative instructions include

1. Avoid lifting heavy objects for at least 6 weeks

2. Refrain from sexual intercourse during the healing period

3. Keep the surgical site clean and dry

4. Take prescribed pain medications and antibiotics as advised

Some patients may experience mild discomfort, urinary frequency, or constipation in the early stages of recovery. These symptoms usually resolve within a few weeks.

Risks and Complications

As with any surgical procedure, POP repair carries certain risks, though complications are relatively rare with experienced surgeons. Potential risks include

1. Infection

2. Bleeding

3. Injury to nearby organs (bladder, rectum, or urethra)

4. Mesh erosion (in surgeries using mesh)

5. Urinary incontinence or retention

6. Recurrence of prolapse

It’s essential to follow up with your surgeon regularly to monitor healing and address any concerns promptly.

Life After Pelvic Organ Prolapse Surgery

Most women experience a significant improvement in quality of life following prolapse surgery. Symptoms like pelvic pressure, urinary urgency, and bulging are usually relieved completely. Long-term success is enhanced by maintaining a healthy weight, avoiding chronic straining or lifting, and practicing pelvic floor exercises as recommended.

For women who have undergone uterine-preserving surgery, fertility may still be possible, though it’s important to consult with a specialist before attempting pregnancy.

Conclusion

The procedure of pelvic organ prolapse repair has evolved into a highly effective and safe treatment for women suffering from this common condition. Whether approached vaginally, laparoscopically, or through abdominal methods, the goal is to restore normal anatomy, alleviate symptoms, and improve daily comfort and functionality.