Pelvic Organ Prolapse (POP) is the descent of the vagina and/or uterus that occurs over time. Such prolapse increases the risk for adjacent organs, such as the bladder and the rectum, to herniate and cause problems such as urinary incontinence, sexual dysfunction, etc. Organs will prolapse (fall out) when there is a loss of support (damage to the connective tissue) due to gravity or an increase in abdominal pressure with exertion. Prolapse is typically worse later in the day after being active, and better first thing in the morning after lying down all night. Fortunately, there are therapies and procedures that can treat POP and its associated symptoms.
Did you know…
Approximately 3% of women in the United States report symptoms of vaginal bulging, but POP can be identified on examination in up to 50% of females? It has been reported that women in the US have a 13% risk of undergoing surgery for POP. Risk factors for developing POP include parity (total number of pregnancies), vaginal delivery, age, obesity, menopause, chronic constipation, connective tissue disorders. It is unclear if a hysterectomy for non-POP conditions is a risk factor for developing POP.
What are the symptoms of POP?
Inability to empty the bladder completely.
Sensation of having a full bladder at all times.
Sensation of pressure in the vagina.
Leaking urine when coughing, sneezing, or lifting.
Recurrent bladder infections (UTI’s)
What surgery is needed to correct POP?
There are several surgeries that can be performed to optimize the correction of the POP. Depending on the type of POP, a specific procedure can be performed.
An enterocele (vaginal herniation of small intestine) is repaired by closing the opening in the connective tissues at the top of the vagina.
A cystocele (vaginal herniation of the bladder) is repaired by incising the vagina anteriorly, replacing the bladder back to its normal anatomical location, and over sewing the stretched connective tissue (anterior repair) or re-attaching the bladder to the sides of the pelvis (paravaginal repair).
A rectocele (vaginal herniation of the rectum) is repaired by incising the vagina posteriorly, identifying tears in the connective tissue between the rectum and vagina, and over sewing the defect.
Stress incontinence is repaired by placement of a permanent sling material tape, or autologous fascia, under the midurethra to provide lifting and support, and ultimately, continence.
These and other procedures may be done while you are under general or spinal anesthesia. Under general anesthesia, you will be asleep and unable to feel pain. With spinal anesthesia, you will be awake, but you will be numb from the waist down and you will not feel pain. You will be given medicines to help you relax.
What should I expect during POP repair?
POP repair may be done while you are under general or spinal anesthesia. Under general anesthesia, you will be asleep and unable to feel pain. With spinal anesthesia, you will be awake, but you will be numb from the waist down and you will not feel pain. You will be given medicines to help you relax. You will receive IV antibiotics and a vaginal douche prior to the procedure(s). You will have a catheter to drain urine during the case.
Will I need to follow any special post-surgical care instructions?
You will be given specific instruction to follow after your procedure. You will have a catheter to drain urine for at least 24 hours after surgery, and it may need to stay in place for several days after surgery. You should avoid any activity that increases your abdominal pressure such as heavy lifting, or constipation. You will be given a mild laxative to prevent constipation and generally should not lift anything heavier than a gallon of milk for six weeks until the scar tissue is strong. You should also avoid intercourse for six weeks to allow proper healing.
Are there any alternatives to treating POP?
Medical and behavioral management is always recommended prior to any surgical intervention. You will be required to learn pelvic floor muscle exercises (Kegel exercises), use estrogen cream in your vagina, or try a device called a pessary in your vagina to hold up the prolapse. If treatment is unsuccessful, contraindicated, and/or not tolerated, then surgery is your next choice.