Understanding Surgery for Pelvic Organ Prolapse: Risks and Alternatives
Pelvic organ prolapse (POP) occurs when the pelvic organs, such as the uterus, bladder, or rectum, slip out of their normal positions. Symptoms may include pain, difficulty urinating, or a persistent feeling of pressure. While non-surgical options like pelvic floor exercises and pessaries are often effective, surgery may be considered for severe cases or when other treatments fail to provide relief.
Before deciding on surgery, it’s essential to understand both the risks and alternative treatments available.
F2:Blood supply and nerve distribution in the pelvis. Adapted from Korean Society of Obstetric and Gynecology, editor. Gynecology. 5th ed. 2015. Fig. 2-3, 2-5; p. 18, 20, with permission of Korean Society of Obstetric and Gynecology [6].View Article:PubMed Central – PubMed
Risks of Surgery for Pelvic Organ Prolapse
While surgery can effectively address prolapse-related issues, it is associated with potential risks, including:
- Infection: Wound infections may occur after any surgical procedure.
- Pain during intercourse: Although not commonly highlighted, scar tissue or structural changes may contribute to this issue.
- Organ injury:
- Bladder or bowel injuries occur in fewer than 1% of anterior wall repair surgeries.
- These injuries are reported in about 2% of sacrocolpopexy or sacrohysteropexy procedures.
- Recurrence of prolapse:
- After anterior repair, recurrence occurs in about 38% of cases within three years.
- Posterior repair shows recurrence in 10–40% of cases.
- Uterine prolapse correction has a 23% recurrence rate within two years.
- Constipation and digestive problems: Adhesions (scar tissue) can lead to restricted bowel movements and poor digestion.
- Restricted range of motion in hip joints: This can develop due to increased fascial pull caused by surgery.
- Lower back pain: Fascial tension post-surgery may contribute to chronic back pain.
While surgery can stabilize the affected organs and alleviate symptoms for most women, the possibility of recurrence or new discomfort emphasizes the need for a well-rounded understanding of options.
Types of Surgery
Surgical options for pelvic organ prolapse aim to restore organ position and improve support. Common procedures include:
- Anterior Vaginal Wall Repair (Anterior Colporrhaphy): Strengthens tissue between the bladder and vagina to lift and support the bladder.
- Posterior Vaginal Wall Repair (Posterior Colporrhaphy): Strengthens tissue between the rectum and vagina to support the bowel.
- Sacrocolpopexy/Sacrohysteropexy: Uses synthetic mesh to attach the top of the vagina or cervix to the sacrum, preserving the uterus when possible.
- Sacrospinous Fixation: Lifts the vagina by attaching it to pelvic ligaments, often performed without synthetic mesh.
Synthetic mesh may stabilize prolapsed organs better but carries risks, such as detachment or complications requiring additional surgery.
Non-Surgical Alternatives to Consider
For many women, non-surgical treatments offer effective symptom management and improved quality of life without the risks of surgery. These include:
- Pelvic Floor Muscle Strengthening: Focused exercises to improve muscle tone and support for pelvic organs.
- Manual Biofeedback for Muscle Coordination: Helps train the pelvic floor muscles for better function.
- Postural Training and Core Stabilization: Correcting structural imbalances to prevent worsening prolapse.
- Education on Proper Lifting Techniques: Reduces strain on the pelvic floor during everyday activities.
- Bowel and Bladder Habit Training: Optimizing bathroom habits to reduce pressure on the pelvic organs.
These approaches, especially when guided by a pelvic health specialist, address the underlying causes of prolapse and prevent its progression.
Schedule a Complimentary Consultation Online to See What’s Right for You
Surgery is a personal decision that should be made after exploring all options, understanding the risks, and consulting with a qualified pelvic health specialist. For some women, surgery may provide much-needed relief, but for others, a tailored program of pelvic floor therapy may offer equally effective results without the associated risks.
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