Surgical treatment of pelvic organ prolapse.

Pelvic Organ Prolapse (POP) is a common condition in women, especially those who have given birth multiple times, are menopausal, or have chronic increased abdominal pressure such as chronic cough, chronic constipation, or regularly lifting heavy objects. Although this condition is not life-threatening, it can significantly affect quality of life, confidence, and relationships. If symptoms are severe or interfere with daily life, surgery is one of the effective and long-lasting treatment options.

 

What is Pelvic Organ Prolapse?

 

The pelvis functions as a “support structure,” similar to a hammock that supports internal organs including the bladder, uterus, small intestine, rectum, and vagina. When the muscles and ligaments that hold these organs weaken, they may descend or protrude into the vaginal canal. This condition can occur in a single location or multiple locations simultaneously, including :

 

     ๐ Uterine prolapse

     ๐ Cystocele (bladder prolapse)

     ๐ Rectocele (rectal prolapse)

     ๐ Enterocele (small intestine prolapse)

     ๐ Vaginal vault prolapse after hysterectomy

 

Common Symptoms

     ๐ Feeling of a lump or bulge in the vagina

     ๐ Heaviness in the lower abdomen or lower back pain

     ๐ Urinary leakage, leaking when coughing or sneezing, incomplete urination

     ๐ Difficulty urinating, needing to strain

     ๐ Constipation or difficulty with bowel movements

     ๐ Pain or discomfort during sexual intercourse

 

When Should Surgery Be Considered?

Treatment for pelvic organ prolapse includes several methods such as:

     1. Pelvic muscle exercises (Kegel exercises)

     2. Use of vaginal support devices (Pessary)

     3. Surgical correction

 

Generally, doctors may consider surgery in cases where:

     ๐ The prolapse is severe (e.g., POP-Q stage 3–4)

     ๐ Symptoms clearly interfere with daily life

     ๐ Non-surgical treatments have failed

     ๐ The patient desires a long-term solution

However, the decision for surgery is not based solely on the “stage” but mainly on symptoms and impact on quality of life.

 

Surgical Treatment Approaches

 

The choice of surgical method depends on the type of prolapsed organ, age, overall health, future childbearing desires, and patient preferences. There are two main approaches:

     1. Vaginal Approach is suitable for those who want to avoid abdominal incisions and prefer a shorter recovery time. Examples of surgeries include:

      ๐ Anterior colporrhaphy (repair of the anterior vaginal wall)

      ๐ Posterior colporrhaphy (repair of the posterior vaginal wall)

      ๐ Vaginal hysterectomy with vault suspension

     

     2. Abdominal Approach provides stronger support for the organs and is suitable in some cases requiring long-term results. Examples include:

      ๐​ Abdominal sacrocolpopexy

      ๐ Laparoscopic sacrocolpopexy

      ๐ Robotic-assisted sacrocolpopexy

     ๐ Sacrohysteropexy (for uterine preservation)

Surgery in this group often uses supportive materials (mesh) to reinforce the support. Mesh offers durability and reduces the chance of recurrent prolapse but carries specific risks such as mesh exposure, which is rare and must be evaluated individually.

 

Minimally Invasive Surgery (MIS)

Currently, laparoscopic or robotic surgery technologies help reduce tissue damage. Key features of MIS include:

     ๐ Small incisions approximately 1–5 cm

     ๐ Less blood loss compared to open abdominal surgery

     ๐ Less pain

     ๐ Shorter hospital stay (usually about 1–3 days)

     ๐ Faster return to daily activities

Current research shows that laparoscopic sacrocolpopexy provides treatment outcomes comparable to open surgery and offers long-term support stability.

 

Preoperative Preparation

     ๐ Physical examination and severity assessment (e.g., POP-Q examination)

     ๐ Evaluation of urinary incontinence in some cases

     ๐ Informing about underlying diseases and regular medications

     ๐ Stopping certain medications such as blood thinners as advised by the doctor

     ๐ Fasting from food and water before surgery as instructed

 

Postoperative Care

     ๐ Hospital stay for 1–3 days (depending on surgical method)

     ๐ Avoid heavy lifting for at least 4–6 weeks

     ๐ Abstain from sexual intercourse for about 6 weeks

     ๐ Regular follow-up appointments with the doctor

 

Possible Complications

Although surgery is generally safe, complications may include:

     ๐ Bleeding

     ๐ Infection

     ๐ Injury to the bladder, intestines, or ureters (rare)

     ๐ ​Temporary difficulty urinating

     ๐ Urinary leakage after surgery in some cases

     ๐ Recurrent prolapse in the long term

 

Pelvic organ prolapse is not something to “endure silently.” Nowadays, there are various safe treatment options ranging from non-surgical treatments to minimally invasive surgery with quick recovery.

 

Consulting a specialist early helps ensure appropriate evaluation, targeted treatment planning, and a confident return to daily life.

 

Source : Phyathai 2 Hospital