Pelvic Organ Prolapse

by Pleas Copas, MD

Pelvic organ prolapse (P.O.P.) affects up to 25% of adult females in the United States, with 11% seeking surgical therapy. P.O.P. includes cystocele (dropped bladder), rectocele (where the wall between the rectum and the vagina drops), and dropped uterus (where the uterus drops onto the top of the vagina).

Symptoms reported by patients include:

  • Pelvic pressure
  • Low back pain
  • Bulging or protruding vaginal tissue, especially when the patient has been lifting, straining or active for long hours
  • Difficulty voiding or having bowel movements
  • Painful sex and tenderness afterward

The most common predisposing factor for P.O.P. is childbirth, even though some women who have P.O.P. have never been pregnant. Normal labor and delivery can damage nerves, muscles, and connective tissues that support the uterus and vagina. Patients may notice prolapse early after delivery, but it is more commonly felt as time passes. Menopause and the resulting estrogen deficiency may contribute to prolapse as well.

The need for treatment mainly depends on the severity of symptoms and the disruption to your lifestyle. If the prolapse is extremely severe or recurrent urinary tract infections are common, your gynecologist may have to recommend treatment.

Treatments may be surgical or non-surgical. The non-surgical route mainly involves the use of a pessary. A pessary is similar to a diaphragm and comes in many different shapes and designs depending on the type of prolapse being treated. It can be worn continuously or only when extremely active, and it must be removed for sexual intercourse. However, most patients chose surgical treatment. The surgical procedures for P.O.P. date back to the late 1800s. Since P.O.P. is essentially a pelvic hernia, many procedures use the same principles to improve symptoms. The surgical procedures can be performed vaginally or through an abdominal incision. More recently, laparoscopic and robotic procedures have been employed.

As with abdominal hernias, mesh has been used in repairing P.O.P. Commercials on TV, ads in newspapers, and billboard designs are prolific in urging patients to take part in class action lawsuits regarding these surgeries; however, the mesh itself is not the main factor behind the controversy. Many inexperienced and insufficiently trained surgeons were enticed to use these valuable products, which resulted in unacceptable complication rates. Several companies have stopped offering the mesh products due to these lawsuits, but they have yet to be removed from the market by the FDA.

As a fellowship-trained physician in Women’s Care Group, I offer my patients a choice of many different approaches to P.O.P. repair. My preference is vaginal surgery. The abdominal wall is not affected, which helps ensure a faster recovery time. Also, I will perform mesh repairs to patients who request them, especially when they have already tried traditional surgeries without success.

With careful selection of procedures, adequate post-operation recovery, and physical and medical therapy when necessary, a satisfactory cure rate of 80-90% can be attained.