Pelvic Organ Prolapse: Should I Have Surgery?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Pelvic Organ Prolapse: Should I Have Surgery?
Get the facts
Your options
- Have surgery for pelvic organ prolapse.
- Manage your symptoms for now without surgery.
Key points to remember
- Pelvic organ prolapse usually causes only mild symptoms. Surgery is usually done only when the prolapse affects your daily life and your doctor thinks surgery will help.
- Many kinds of surgery can be done for pelvic organ prolapse. The type of surgery you have will depend on which organs have prolapsed.
- Consider surgery if the prolapse is causing pain, if you are having problems with your bladder and bowels, or if the prolapse is making it hard for you to do activities you enjoy.
- An organ can prolapse again after surgery. Surgery in one part of your pelvis can make a prolapse in another part worse. This may mean that you will need to have another surgery later.
- You might be able to relieve some symptoms without surgery. You can do exercises at home that make your pelvic muscles stronger. And you can try pelvic floor physiotherapy.
- If you choose, your doctor can fit you with a device called a pessary. A pessary can help you cope with pelvic organ prolapse. It's a removable device that fits in your vagina and holds your pelvic organs in place.
FAQs
Pelvic organ prolapse occurs when a pelvic organ, such as your bladder, drops (prolapses) from its normal spot in your lower belly and pushes against the sides of your vagina. This can happen when the muscles that hold your pelvic organs in place get weak or damaged from childbirth, for example.
More than one pelvic organ can prolapse at the same time. Other organs that can be involved when you have pelvic prolapse include your:
Pelvic organ prolapse usually causes only mild symptoms. Surgery is usually done only when the prolapse is affecting your daily life and your doctor thinks surgery will help. Consider surgery if:
- The prolapse causes pain.
- You have problems with your bladder and bowels.
- The prolapse makes it hard for you to do activities you enjoy.
Many kinds of surgery can be done for pelvic organ prolapse. The type of surgery you have will depend on which organs are prolapsed.
Types of surgery include:
- Surgery to repair and restore the tissue in the area of the prolapse (restorative surgery).
- Surgery to close the vagina (vaginal obliteration). This surgery is only an option if you no longer want to have vaginal sex.
- Removal of the uterus (hysterectomy).
During restorative surgery for bladder, urethra, rectum, and small bowel prolapse, the surgeon makes a cut, called an incision, in the wall of the vagina. The surgeon pulls together the loose or torn tissue in the area of the prolapsed organ and strengthens the wall of the vagina to keep the prolapse from coming back.
During restorative surgery for vaginal vault prolapse, the surgeon makes an incision in the wall of the vagina. The surgeon attaches the top of the vagina to the wall of the lower belly, to the spine in the lower back, or to the ligaments of the pelvis.
During a hysterectomy, the surgeon removes the uterus.
During a vaginal obliteration, the surgeon removes most of the vaginal lining and then sews the vagina shut. If you still have a uterus, the doctor leaves a small opening to allow fluid to drain from the uterus.
These surgeries are usually done by a gynecologist or a urologist. You will have medicine to make you sleepy during the surgery (anesthesia). You may stay in the hospital for a day or two. You may go home with a catheter, a flexible plastic tube that drains urine from your bladder when you can't urinate by yourself.
After surgery, you will likely be able to return to your normal activities in about 6 weeks.
For the first 3 months after surgery, you will need to take it easy and avoid heavy lifting or long periods of standing. Your prolapse can return if you strain or lift too soon after surgery.
It may be best to delay surgery if you plan to get pregnant in the future. The strain of childbirth could cause your problem to come back.
Problems you may have after surgery can include:
- Trouble controlling your bladder (incontinence).
- Not being able to empty your bladder.
- Pain during sex.
- Infection.
- Bladder injury.
- A hole or opening that forms between two organs in your body, or between your body and your skin. This is called a fistula.
Since surgery for pelvic organ prolapse is done to treat symptoms caused by one prolapsed organ, you may still have other symptoms after your surgery.
Pelvic organ prolapse can come back after surgery. How well surgery works depends on the type of surgery. But about 5 to 20 out of 100 people have a second surgery within 3 years.footnote 1, footnote 2 This means that about 80 to 95 out of 100 people don't have a second surgery within 3 years.
You may be able to relieve some symptoms of pelvic organ prolapse on your own.
- Try exercises called Kegels to make your pelvic muscles stronger.
- Ask your doctor about pelvic floor physiotherapy. A specialized physiotherapist can help you with exercises and may use other techniques to help your symptoms.
- Eat foods that are high in fibre to avoid constipation and straining when you have a bowel movement.
- Reach and stay at a healthy weight, since more weight puts pressure on your pelvic muscles.
- Avoid lifting heavy things that put stress on your pelvic muscles.
If you choose, your doctor can fit you with a device called a pessary. A pessary can help you cope with pelvic organ prolapse. It's a removable device that you put in your vagina. It holds the pelvic organs in place. Pessaries can be useful if you don't want or can't have surgery. Many people can control their symptoms for years by using a pessary.
Your doctor may encourage you to have surgery for pelvic organ prolapse if:
- Your symptoms are painful or are affecting your quality of life.
- Non-surgical treatments, such as using a pessary or special exercises, have not helped or you don't prefer them.
Compare your options
| |
|---|
What is usually involved? |
| |
|---|
What are the benefits? |
| |
|---|
What are the risks and side effects? |
| |
|---|
Surgery for pelvic organ prolapseSurgery for pelvic organ prolapse- You will probably stay in the hospital for a day or two.
- After surgery, you will likely be able to return to your normal activities in about 6 weeks.
- For the first 3 months after surgery, you will need to get more rest and avoid heavy lifting or long periods of standing.
- You have relief from pain.
- You have more control over your bladder and bowels.
- You have a better quality of life.
- A pelvic organ prolapse may come back after surgery.
- If you have more than one prolapsed organ, you may still have symptoms after surgery.
- Surgery can leave you with other problems such as incontinence, pain during sex, and bladder injury.
Managing your symptomsManaging your symptoms- You do exercises called Kegels to make your pelvic muscles stronger.
- You try pelvic floor physiotherapy.
- You try to reach and stay at a healthy weight.
- You may be fitted for a pessary by your doctor. A pessary is a device that holds pelvic organs in place.
- You have some pain relief.
- You have more control over your bladder and bowels with exercise or a pessary.
- You may still have symptoms that affect your quality of life.
- You may still need surgery.
My bladder pushes into my vagina, and I can feel it all the time. Sometimes it seems like it's going to fall right out. It's uncomfortable and gets in the way when I play tennis or run. I'm going to have the surgery.
I didn't know I had a medical problem until I had my yearly pelvic exam. I had some discomfort, mostly pressure in my abdomen, but I didn't know what it was. It doesn't bother me on a daily basis. My doctor gave me a sheet with some exercises that I can do to make my pelvic muscles stronger. My symptoms aren't a big problem for me right now. I'm going to wait and see what happens over time.
I've been trying to cope with this problem for years. I've tried a lot of different things, even a pessary for a while. But my condition isn't getting better. It might even be getting worse. I think surgery could help me.
I have five grown children and 12 grandchildren. I'm proud of how fit and active I am. My biggest problem is that often I really have to urinate and I can't. I've found ways to manage, though, by putting my fingers in my vagina and pressing on my bladder. It's not the greatest solution but I think I'd like to keep on the way I have for a while longer. Surgery is still an option for me, but I'm not going to choose it now.
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery for pelvic organ prolapse
Reasons to manage symptoms for now without surgery
My symptoms are painful and bother me. They affect my daily life.
My symptoms aren't that bad. They don't get in the way of my daily life.
More important
Equally important
More important
My condition makes it hard for me to enjoy sex.
My condition hasn't affected my sex life.
More important
Equally important
More important
Resting and being less active for 3 months after surgery won't be a problem for me.
I can't rest and be less active for 3 months while I recover from surgery.
More important
Equally important
More important
I don't plan to get pregnant in the future.
I plan to get pregnant in the future.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Surgery
Managing symptoms without surgery
Leaning toward
Undecided
Leaning toward
What else do you need to make your decision?
1. How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
3. Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Next steps
Which way you're leaning
How sure you are
Your comments
Key concepts that you understood
Key concepts that may need review
Credits
| Author | Healthwise Staff |
|---|
| Clinical Review Board | Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
|---|
References
Citations
- Maher C, et al. (2016). Surgery for women with anterior compartment prolapse. Cochrane Database of Systematic Reviews, 11: CD004014. DOI: 10.1002/14651858.CD004014.pub6. Accessed September 26, 2022.
- Maher C, et al. (2016). Surgery for women with apical vaginal prolapse. Cochrane Database of Systematic Reviews, 10: CD012376. DOI: 10.1002/14651858.CD012376. Accessed September 26, 2022.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Pelvic Organ Prolapse: Should I Have Surgery?
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the Facts
Your options
- Have surgery for pelvic organ prolapse.
- Manage your symptoms for now without surgery.
Key points to remember
- Pelvic organ prolapse usually causes only mild symptoms. Surgery is usually done only when the prolapse affects your daily life and your doctor thinks surgery will help.
- Many kinds of surgery can be done for pelvic organ prolapse. The type of surgery you have will depend on which organs have prolapsed.
- Consider surgery if the prolapse is causing pain, if you are having problems with your bladder and bowels, or if the prolapse is making it hard for you to do activities you enjoy.
- An organ can prolapse again after surgery. Surgery in one part of your pelvis can make a prolapse in another part worse. This may mean that you will need to have another surgery later.
- You might be able to relieve some symptoms without surgery. You can do exercises at home that make your pelvic muscles stronger. And you can try pelvic floor physiotherapy.
- If you choose, your doctor can fit you with a device called a pessary. A pessary can help you cope with pelvic organ prolapse. It's a removable device that fits in your vagina and holds your pelvic organs in place.
FAQs
What is pelvic organ prolapse?
Pelvic organ prolapse occurs when a pelvic organ, such as your bladder, drops (prolapses) from its normal spot in your lower belly and pushes against the sides of your vagina. This can happen when the muscles that hold your pelvic organs in place get weak or damaged from childbirth, for example.
More than one pelvic organ can prolapse at the same time. Other organs that can be involved when you have pelvic prolapse include your:
Pelvic organ prolapse usually causes only mild symptoms. Surgery is usually done only when the prolapse is affecting your daily life and your doctor thinks surgery will help. Consider surgery if:
- The prolapse causes pain.
- You have problems with your bladder and bowels.
- The prolapse makes it hard for you to do activities you enjoy.
What kinds of surgery are done for pelvic organ prolapse?
Many kinds of surgery can be done for pelvic organ prolapse. The type of surgery you have will depend on which organs are prolapsed.
Types of surgery include:
- Surgery to repair and restore the tissue in the area of the prolapse (restorative surgery).
- Surgery to close the vagina (vaginal obliteration). This surgery is only an option if you no longer want to have vaginal sex.
- Removal of the uterus (hysterectomy).
During restorative surgery for bladder, urethra, rectum, and small bowel prolapse, the surgeon makes a cut, called an incision, in the wall of the vagina. The surgeon pulls together the loose or torn tissue in the area of the prolapsed organ and strengthens the wall of the vagina to keep the prolapse from coming back.
During restorative surgery for vaginal vault prolapse, the surgeon makes an incision in the wall of the vagina. The surgeon attaches the top of the vagina to the wall of the lower belly, to the spine in the lower back, or to the ligaments of the pelvis.
During a hysterectomy, the surgeon removes the uterus.
During a vaginal obliteration, the surgeon removes most of the vaginal lining and then sews the vagina shut. If you still have a uterus, the doctor leaves a small opening to allow fluid to drain from the uterus.
These surgeries are usually done by a gynecologist or a urologist. You will have medicine to make you sleepy during the surgery (anesthesia). You may stay in the hospital for a day or two. You may go home with a catheter, a flexible plastic tube that drains urine from your bladder when you can't urinate by yourself.
After surgery, you will likely be able to return to your normal activities in about 6 weeks.
For the first 3 months after surgery, you will need to take it easy and avoid heavy lifting or long periods of standing. Your prolapse can return if you strain or lift too soon after surgery.
It may be best to delay surgery if you plan to get pregnant in the future. The strain of childbirth could cause your problem to come back.
What are the risks of surgery for pelvic organ prolapse?
Problems you may have after surgery can include:
- Trouble controlling your bladder (incontinence).
- Not being able to empty your bladder.
- Pain during sex.
- Infection.
- Bladder injury.
- A hole or opening that forms between two organs in your body, or between your body and your skin. This is called a fistula.
Since surgery for pelvic organ prolapse is done to treat symptoms caused by one prolapsed organ, you may still have other symptoms after your surgery.
Pelvic organ prolapse can come back after surgery. How well surgery works depends on the type of surgery. But about 5 to 20 out of 100 people have a second surgery within 3 years.1, 2 This means that about 80 to 95 out of 100 people don't have a second surgery within 3 years.
What are your other choices besides surgery?
You may be able to relieve some symptoms of pelvic organ prolapse on your own.
- Try exercises called Kegels to make your pelvic muscles stronger.
- Ask your doctor about pelvic floor physiotherapy. A specialized physiotherapist can help you with exercises and may use other techniques to help your symptoms.
- Eat foods that are high in fibre to avoid constipation and straining when you have a bowel movement.
- Reach and stay at a healthy weight, since more weight puts pressure on your pelvic muscles.
- Avoid lifting heavy things that put stress on your pelvic muscles.
If you choose, your doctor can fit you with a device called a pessary. A pessary can help you cope with pelvic organ prolapse. It's a removable device that you put in your vagina. It holds the pelvic organs in place. Pessaries can be useful if you don't want or can't have surgery. Many people can control their symptoms for years by using a pessary.
Why might your doctor recommend surgery?
Your doctor may encourage you to have surgery for pelvic organ prolapse if:
- Your symptoms are painful or are affecting your quality of life.
- Non-surgical treatments, such as using a pessary or special exercises, have not helped or you don't prefer them.
2. Compare your options
| Surgery for pelvic organ prolapse | Managing your symptoms |
|---|
| What is usually involved? | - You will probably stay in the hospital for a day or two.
- After surgery, you will likely be able to return to your normal activities in about 6 weeks.
- For the first 3 months after surgery, you will need to get more rest and avoid heavy lifting or long periods of standing.
| - You do exercises called Kegels to make your pelvic muscles stronger.
- You try pelvic floor physiotherapy.
- You try to reach and stay at a healthy weight.
- You may be fitted for a pessary by your doctor. A pessary is a device that holds pelvic organs in place.
|
|---|
| What are the benefits? | - You have relief from pain.
- You have more control over your bladder and bowels.
- You have a better quality of life.
| - You have some pain relief.
- You have more control over your bladder and bowels with exercise or a pessary.
|
|---|
| What are the risks and side effects? | - A pelvic organ prolapse may come back after surgery.
- If you have more than one prolapsed organ, you may still have symptoms after surgery.
- Surgery can leave you with other problems such as incontinence, pain during sex, and bladder injury.
| - You may still have symptoms that affect your quality of life.
- You may still need surgery.
|
|---|
Personal stories
Personal stories about surgery for pelvic organ prolapse
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"My bladder pushes into my vagina, and I can feel it all the time. Sometimes it seems like it's going to fall right out. It's uncomfortable and gets in the way when I play tennis or run. I'm going to have the surgery."
"I didn't know I had a medical problem until I had my yearly pelvic exam. I had some discomfort, mostly pressure in my abdomen, but I didn't know what it was. It doesn't bother me on a daily basis. My doctor gave me a sheet with some exercises that I can do to make my pelvic muscles stronger. My symptoms aren't a big problem for me right now. I'm going to wait and see what happens over time."
"I've been trying to cope with this problem for years. I've tried a lot of different things, even a pessary for a while. But my condition isn't getting better. It might even be getting worse. I think surgery could help me."
"I have five grown children and 12 grandchildren. I'm proud of how fit and active I am. My biggest problem is that often I really have to urinate and I can't. I've found ways to manage, though, by putting my fingers in my vagina and pressing on my bladder. It's not the greatest solution but I think I'd like to keep on the way I have for a while longer. Surgery is still an option for me, but I'm not going to choose it now."
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery for pelvic organ prolapse
Reasons to manage symptoms for now without surgery
My symptoms are painful and bother me. They affect my daily life.
My symptoms aren't that bad. They don't get in the way of my daily life.
More important
Equally important
More important
My condition makes it hard for me to enjoy sex.
My condition hasn't affected my sex life.
More important
Equally important
More important
Resting and being less active for 3 months after surgery won't be a problem for me.
I can't rest and be less active for 3 months while I recover from surgery.
More important
Equally important
More important
I don't plan to get pregnant in the future.
I plan to get pregnant in the future.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Surgery
Managing symptoms without surgery
Leaning toward
Undecided
Leaning toward
5. What else do you need to make your decision?
Check the facts
1. I should have surgery only if the prolapse is affecting my daily life and my doctor thinks surgery will help.
You are right. Surgery is usually done only when the prolapse is affecting your daily life and your doctor thinks surgery will help.
2. If I have surgery, it will relieve all my symptoms.
You are right. Surgery is done to treat symptoms caused by one prolapsed organ, so you may still have other symptoms after your surgery.
3. Getting surgery is the only way to relieve my symptoms of pelvic organ prolapse.
You're right. You may be able to relieve some symptoms on your own. You can try exercises called Kegels to make your pelvic muscles stronger. Or you can ask your doctor about pelvic floor physiotherapy or using a pessary.
4. I may need to have surgery more than once for my pelvic organ prolapse.
You are right. About 5 to 20 out of 100 people have a second surgery within 3 years.
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
Credits
| By | Healthwise Staff |
|---|
| Clinical Review Board | Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
|---|
References
Citations
- Maher C, et al. (2016). Surgery for women with anterior compartment prolapse. Cochrane Database of Systematic Reviews, 11: CD004014. DOI: 10.1002/14651858.CD004014.pub6. Accessed September 26, 2022.
- Maher C, et al. (2016). Surgery for women with apical vaginal prolapse. Cochrane Database of Systematic Reviews, 10: CD012376. DOI: 10.1002/14651858.CD012376. Accessed September 26, 2022.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.Current as of: November 27, 2023
Author: Healthwise Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
Maher C, et al. (2016). Surgery for women with anterior compartment prolapse. Cochrane Database of Systematic Reviews, 11: CD004014. DOI: 10.1002/14651858.CD004014.pub6. Accessed September 26, 2022.
Maher C, et al. (2016). Surgery for women with apical vaginal prolapse. Cochrane Database of Systematic Reviews, 10: CD012376. DOI: 10.1002/14651858.CD012376. Accessed September 26, 2022.
