Pelvic Organ Prolapse

Pelvic organ prolapse (POP) may result in “dropping” of bladder, rectum, uterus, vagina, or small intestine. It is not life threatening, and treatment with surgery or a pessary is not necessary in all cases. The biggest risk factor is childbirth and its associated trauma to muscle, nerves, and support structures. Other risk factors for progression include lifting heavy weights, chronic coughing, chronic constipation, weight gain, or anything that increases pressure in the abdomen. There is no way to predict the natural progression of pelvic organ prolapse. The symptom severity described by women is the typical criteria for treatment.

Surgical reconstruction of pelvic organ prolapse includes vaginal and/or laparoscopic approaches to repair cystocele, rectocele, enterocele, and/or vaginal or uterine prolpase. A large abdominal incision is rarely needed in this era. The use of mesh is not always recommended and there are several 'native tissue' surgical options available. Surgery is intended to reduce prolapse and eliminate symptoms of vaginal pressure and protrusion. Surgery is NOT intended to eliminate voiding or defecatory symptoms, but these symptoms may indirectly resolve. Hysterectomy is not necessary in all cases. Risks of surgery include bleeding, infection, injury to surrounding organs, recurrence, frequency, retention, incontinence, mesh erosion, and risks of anesthesia. Success of pelvic surgery may be as high as 90%. Surgery may require a short hospital stay in some cases. Recovery may occur as early as 1-2 weeks but may take up to 6 weeks in some cases. Post-operative instructions include weight lifting limits, constipation prevention, pelvic rest, and pool/beach restriction.

Pelvic organ prolapse can also be managed with a device called a pessary. A pessary is a silicone device inserted into the vagina to reduce prolapse. It comes in various shapes and sizes. Several fittings may be necessary to find an appropriately fitted pessary. A correctly fitted pessary is one that will stay in place, eliminate symptoms, and is comfortable. Women may manage a pessary by themselves, or return periodically for pessary removal, cleaning, and inspection. Women who are sexually active may prefer to remove the pessary before intercourse. Vaginal estrogen may be necessary to maintain skin integrity.