Pelvic Organ Prolapse Surgery: Everything You Need to Know

Surgery is a treatment option

Close up of doctor writing on a medical chart.
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A vaginal hernia, also called pelvic organ prolapse, can be surgically corrected. Herniation of the bladder into the vagina is the most common type of vaginal herniation, but other organs in the pelvis can sink into the vagina as well. Pelvic organ prolapse surgery is aimed at reducing symptoms, such as pelvic pressure and urine leaks, by placing the pelvic structures back into their position and surgically creating support for the prolapsed organs. It takes several weeks to recover after surgery, and you may have some activity restrictions while you are healing.

What Is Pelvic Organ Prolapse Surgery?

Pelvic organ prolapse surgery is a surgical operation that lifts pelvic organs that have sunk into the vagina. Prolapsed organs can include the bladder, rectum, uterus, intestine, or the upper part of the vagina.

This type of surgery involves reinforcing ligaments and muscles with sutures, and possibly includes placement of artificial mesh if the existing connective tissue and muscles cannot be repaired or strengthened.

Surgical correction of pelvic organ prolapse can be done transvaginally (through the vagina), laparoscopically (with a small lower abdominal incision), or as a robot-assisted procedure. All of these approaches are done with a surgical device that's equipped with a camera.

Sometimes extensive operations with hysterectomy (removal of the uterus) are done with an open laparotomy and a large lower abdominal incision.

Vaginal prolapse surgery is done with general anesthesia for pain control.

Surgeries done for repairing pelvic organ prolapse include:

  • Anterior vaginal wall repair: Strengthening connective tissue between the vagina and the bladder is done transvaginally or through the abdomen.
  • Posterior vaginal wall repair: Strengthening the connective tissue between the vagina and the rectum is usually done transvaginally.
  • Sacrocolpopexy: Attaching the top of the vagina to the tailbone is usually done with an abdominal incision.
  • Sacrohysteropexy: Attaching the cervix (upper part of the vagina) to the tailbone is usually done with an abdominal incision.
  • Sacrospinous fixation: Attaching the vagina to the ligaments of the pelvis is usually done transvaginally.

Reconstructive surgery may be done to maintain the position of the pelvic structures. And sometimes obliterative surgery is done, in which the vaginal wall is surgically narrowed as a means of supporting the pelvic structures.

Sexual function is possible after reconstructive pelvic organ prolapse surgery, but not after obliterative pelvic organ prolapse surgery.

Contraindications

You might not be able to have pelvic organ prolapse surgery if you have a high risk of complications. For instance, a history of adhesions (surgical scarring), major medical illnesses, or a bleeding disorder can lead to substantial problems after surgery.

Pelvic organ prolapse surgery can include a hysterectomy if the uterus is prolapsed. However, after hysterectomy, a woman cannot become pregnant and will experience medical menopause, so the decision to have the uterus removed has to be made with these considerations in mind.

Potential Risks

There are side effects associated with general anesthesia and surgery.

Additionally, pelvic organ prolapse surgery can cause:

  • Bleeding
  • Infections
  • Injury to the structures in the pelvis
  • Adhesions

Sometimes mesh is used in pelvic organ prolapse surgery. The Food and Drug Administration has issued a statement about the possible complications of mesh, which include pain, recurrent prolapse, and injuries that require surgical intervention. Transvaginal mesh is associated with a higher complication rate than abdominally placed mesh.

Purpose of Pelvic Organ Prolapse Surgery

Pelvic organ prolapse surgery is done to remove pressure on the vagina from pelvic organs. The pressure can cause incontinence of urine or stool, infections, and erosion of the vaginal tissue.

Most women with pelvic organ prolapse don't experience any noticeable effects, but symptoms can include:

  • Bulging in the vagina
  • Heaviness, fullness, aching, or pulling in the vagina, often worsening at the end of the day or during a bowel movement
  • Difficulty completely emptying the bladder
  • Pain with urination
  • Sexual difficulties
  • Urinary tract infections
  • Leaking urine, especially while coughing, exercising, or laughing
  • Constipation
  • Leaking stool
  • Trouble controlling gas

Generally, surgery is not necessary if there are no clinical effects of a vaginal herniation. And conservative management, such as pelvic floor exercises or placement of a pessary, is often effective for reducing the symptoms of pelvic organ prolapse.

Surgery may be considered when conservative measures have not worked.

There are different types of vaginal hernias:

  • A cystocele is herniation of the bladder into the vagina, and it is located in the anterior vaginal wall (front wall of the vagina).
  • A urethrocele is a sagging of the urethra, which is the duct that urine travels through before exiting the body.
  • A rectocele is a herniation of the rectum into the vagina, and it is located in the posterior vaginal wall (back wall of the vagina).
  • An enterocele is a hernia of the small bowel into the vagina, and it usually results from loss of pelvic support at the top of the vagina, close to the cervix.
  • Uterine prolapse is herniation of the uterus into the vagina, and it results from weakness of the cardinal or uterosacral ligaments that support the uterus.

Injury or weakness in the pelvic floor muscles can cause pelvic organs to drop into the vagina. When the pelvic support structures weaken, it's likely that two or three pelvic organs can drop together—you may have a cystocele with a urethrocele or another combination of prolapse.

Your specific pelvic organ prolapse symptoms depend on which pelvic organs have herniated through your vagina. For instance, cystoceles cause urinary symptoms.

How to Prepare

Your surgery preparation includes an assessment of the anatomical structures involved in your vaginal hernia for procedural planning, as well as tests for anesthesia preparation.

Your doctor will listen to your symptoms and do a pelvic examination. Diagnostic imaging tests such as abdominal and pelvic computerized tomography (CT) will be used to assess the organs that have prolapsed and the extent of the prolapse. Additionally, your surgical planning includes a decision about whether you will need surgical mesh placement for support of your pelvic organs.

You will also have a urinalysis or urine function tests, like a voiding cystourethrogram (VCUG) test to assess bladder involvement.

Your pre-anesthesia testing will include a complete blood count (CBC), blood chemistry tests, a chest X-ray, and an electrocardiogram (EKG).

Location

You will have your surgery in a hospital operating room. You will need to stay in the hospital for a few days after your surgery before getting discharged to go home.

What to Wear

You can wear anything comfortable to your surgery appointment. You should have something to wear that is loose and comfortable on your way home because you may have some soreness and swelling around your pelvic and lower abdominal area.

Food and Drink

You will need to abstain from food and drink after midnight the night before your pelvic prolapse surgery.

Medications

You may need to make some adjustments to your medications in the week before your surgery. If you regularly take blood thinners, your doctor will give you instructions about stopping or decreasing your dose. Additionally, you may need to temporarily adjust your dose of diabetes medication, steroids, or non-steroidal anti-inflammatories in the days before your surgery.

What to Bring

When you go to your appointment, you need to make sure that you have your identification, insurance information, and payment for any portion of your surgery that you might be required to pay.

You will need to have someone who can drive you home when you are discharged from the hospital after your surgery.

Pre-Op Lifestyle Changes

You shouldn't have to make any lifestyle changes in preparation for your surgery.

What to Expect on the Day of Surgery

When you go to your surgery appointment, you will need to register and sign a consent form.

You will go to a pre-operative area where your temperature, pulse, blood pressure, respiratory rate, and oxygen saturation will be monitored. You will have an intravenous (IV, in a vein) line placed on your arm or hand to be used for medication administration, such as anesthetic medications.

You may have same-day tests, such as CBC, blood chemistry levels, and a urine test.

You may have a urinary catheter placed in the pre-operative area or when you go to the operating room. And your surgeon and anesthesiologist may examine you before your procedure.

Before the Surgery

When you go to the operating room, you will have your anesthesia started and your surgical area (vagina or abdomen) will be cleansed.

Your anesthesia will be started with medications injected in your IV to make you sleep, to prevent you from feeling pain, and to reduce your muscle movement. You will have a breathing tube placed in your throat so that you will have mechanically assisted breathing throughout your surgery. Your blood pressure, pulse. breathing and oxygen saturation will be monitored throughout your procedure.

You will also have a surgical drape placed over your abdomen and pelvis. The surgical area will be exposed and cleaned with an antiseptic solution.

During the Surgery

Your surgery will begin as your surgeon makes an incision in your abdomen or vagina. For a transvaginal procedure, you will have a small incision, measuring about an inch in length. For a laparoscopic abdominal procedure, the incision will be small, measuring about an inch. For an open laparotomy, the incision will be larger, measuring between three and six inches.

If your surgery will be done with a laparoscopic device, the device will be inserted to give your surgeon a view of structures in your pelvis with the camera.

The herniated structures will be located. Your surgeon will gently move your pelvic organs into the optimal position.

Your surgeon will use one or more techniques for maintaining support of your pelvic organs, which can include:

  • Placing mesh to hold the herniated organs in place
  • Strengthening muscle and/or ligaments by repositioning them and holding them together with sutures
  • Attaching a portion of your vagina to nearby structures
  • Tightening your vaginal wall

After the structures are held into place, the laparoscopic device (if your surgeon is using one) and any surgical tools are removed. The incision in the abdomen or vagina will be closed with sutures, and the wound will be covered with surgical bandages.

When your surgery is complete, your anesthetic medication will be stopped or reversed, and the breathing tube will be removed. Your anesthesia team will make sure you can breathe on your own before you are taken to the recovery area.

After the Surgery

When you go to the recovery area, you will be waking up. You will receive pain medication as needed. You will stay in the hospital for a few days after your surgery, so you will go to a hospital room within a few hours after your surgery.

Your urinary catheter will be removed approximately two days after your surgery.

Before your discharge from the hospital, your surgical team will ensure that you can pass urine on your own and that you can pass stool and gas without difficulty. You may have some vaginal bleeding or blood in your urine, and your surgical team will also monitor the amount of blood to ensure that you are properly healing.

If you are recovering as expected while in the hospital, you will be able to go home with instructions—when to make a follow-up appointment, how to care for your wound, signs of complications to look out for, activity restrictions, and how to take your pain medication.

Recovery

It will take several weeks for you to recover after your vaginal hernia surgery. In the meantime, you will have restrictions regarding driving, exercising, and heavy lifting.

You will need to see your doctor within a week and again several weeks after surgery. Your doctor will examine your wound and remove stitches. You may also have imaging tests to assess the repair.

Healing

You can take pain medication as directed while you are healing. As you are healing, you may have some vaginal bleeding or blood in your urine. It is important that you understand what to expect and that you contact your surgeon's office if you are having more bleeding than anticipated.

You may need pain medication, and you can use cold packs to reduce pelvic swelling. You also need to keep your wound clean and dry as you are healing.

Signs of complications to look out for include:

  • Fever
  • Worsening or excessive pain
  • Blood clots in the urine or from the vagina
  • Puss coming from the wound
  • Redness or tenderness around the wound
  • Severe constipation
  • Inability to pass urine
  • Abdominal distension (enlargement)

Call your doctor's office if you experience any of these issues.

Coping With Recovery

As you are recovering, you will need to limit your physical activity. You should move around as directed by your doctor. This might mean taking short walks or just walking around your house. It is dangerous to completely lie in bed for weeks because that can increase the risk of blood clots and muscle atrophy (thinning).

Your doctor will advise you to abstain from sexual intercourse for several weeks while you are recovering.

After several weeks, you will be able to increase your physical activity as tolerated. Make sure you follow instructions regarding activity because not all pelvic organ prolapse surgery is the same—some procedures involve more extensive repair than others and can take longer to recover from.

Long Term Care

If you have had a hysterectomy and haven't already reached menopause, then you will experience menopause abruptly after your surgery. This can cause a number of issues, such as fatigue, osteoporosis, and weight changes. You and your doctor may discuss long term treatment, such as hormone replacement therapy.

Possible Future Surgeries

Vaginal hernia repair surgery is intended as a one-time procedure, but you can be at risk of recurrent pelvic organ prolapse after a surgical repair.

If you develop recurrent pelvic organ prolapse or complications, such as due to mesh placement, you may need one or more additional surgical procedures for repair.

Lifestyle Adjustments

You may need to make major lifestyle adjustments after pelvic organ prolapse surgery. If you have had an obliterative procedure, this means that you already decided that you will not have vaginal intercourse after your surgery. That can be a major adjustment, even if you have known about and agreed to this consequence prior to your surgery. You may benefit from speaking to a therapist about how this change affects you.

Additionally, you may need to make adjustments to your bowel and bladder habits. For instance, you might make sure that you are near a toilet in case you experience urgency. Or your doctor may advise you to periodically empty your bladder on a schedule to avoid leaking.

A Word From Verywell

Often, vaginal herniation doesn't require intervention or it can be managed with non-surgical methods. If you have pelvic organ prolapse, you may have subtle effects that can get worse over time, so it's important that you talk to your doctor if you experience bladder issues or pelvic pressure. Surgery is not the most common treatment for pelvic organ prolapse, but it is often necessary to prevent serious complications.

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