Are prolapse operations successful?

A pelvic organ prolapse, or POP for short, happens when one or more organs in the pelvis move downwards from their normal position and bulge into the vagina. There are three main types:

• Anterior – This happens when the bladder drops from its normal position
• Posterior – This happens when the bowels bulge into or out of the vagina.
• Uterine – This happens when the uterus drops from its normal position

Unfortunately, there is still a lot of shame around this subject and conditions, causing a lot of women to receive misinformation or terrible to little advice. 

So what are the symptoms?

It’s important to note that it is not life-threatening but can cause a huge amount of distress and discomfort. The most commonly reported symptoms are:

• Leaking a small amount of urine when coughing, sneezing or exercising. 
• Going to the toilet more 
• Feeling a heaviness or ‘dragging’ feeling in your lower tummy 
• Feeling like there is something moving down your vagina 
• Seeing a bulge coming out of your vagina 
• A numb feeling or pain during sex

Because of the stigma, it’s unclear exactly how many women are affected but it’s thought that nearly 50% of women experience some form of POP[1]. Many women can experience POP as a result of difficult or multiple childbirths, transitioning into the menopause. 

What treatments are available?

Before considering surgery, there are several treatment options which could help to alleviate symptoms.

Some lifestyle changes such as losing weight, not lifting heavy objects and eating a diet high in fibre could prevent prolapse symptoms from getting worse. 

Pelvic floor exercises or kegels can be a helpful way to make sure that the pelvic floor is able to contract and release effectively but they are just a piece of the puzzle and shouldn’t be considered the only way to support your prolapse better. There are also a number of additional exercises you can do to support your recovery journey, including: 

• Arm circles
• Rib Cage Release
• Hip release
• Ball Squeeze
• Bridges

You may feel like some of these are unrelated to prolapse symptoms but addressing things like your breathing, your posture and tightness around the pelvis are all vital to alleviate prolapse symptoms. 

For information on how to carry out these exercises, have a read of my ‘Will pelvic floor exercises help prolapse?’ blog. 

Other treatments that could be tried are hormone treatments and vaginal pessaries. You can get advice about these from your GP but ideally, get a referral to a women’s health physio. 

What if I need surgery?

If your quality of life is being affected, you may decide to have surgery to repair your prolapse. It is important to address the issues that contributed to the prolapse in the first place as otherwise, your symptoms are more likely to return. 

Here are some examples of things that should be addressed before having surgery: 

• If your posture causes you to put downward pressure onto your pelvic floor, you need to find ways to reduce that pressure, possibly by strengthening your spinal muscles to create more length in your body. 
• If your breathing tends to move down into your belly, rather than spreading equally throughout your torso, you need to create new breathing patterns. 
• If you find it hard to control intra-abdominal pressure due to lack of strength, you need to strengthen your pelvic floor muscles, your abdominal muscles and your whole body globally to reduce the pressure going into your pelvic floor day to day. 
• If you are constipated, you need to address this to ensure that the pressure created by straining is not continuing post-surgery. 

Without these kinds of holistic changes, your pelvic floor surgery is more likely to be unsuccessful. 

Anterior repair 

The procedure will focus on reinforcing the weakened layers between the bladder and the vagina to improve overall bladder function and reduce any vagina bulging. 

It’s thought that this procedure is around 70-90% successful (Source: Bladder & Bowel).

I believe this figure could be improved if information about pelvic floor health and a more holistic approach (as outlined above) was discussed with the post-surgery team. 

Posterior Repair 

The procedure will focus on reinforcing the weakened layers between the rectum and the vagina to improve overall bowel function and reduce any vagina bulging. 

It’s thought that this procedure is around 80-90% successful (Source: Bladder & Bowel).

Vaginal Hystorectomy 

When the uterus drops a vaginal hysterectomy to surgically remove the uterus may be advised. It’s thought that this procedure is around 85% successful  (Source: Bladder & Bowel) but it is possible that some women will develop a further prolapse of the vaginal vault further down the line. 

It is important to remember that a prolapse can recur or another part of the vaginal wall may prolapse. This may be inevitable in some circumstances but I believe it is less likely when a holistic approach is taken and when people are better informed and empowered about their pelvic floor health. Healing post-surgery takes around 3 months and any heavy lifting and strenuous exercises should be avoided. You should consider a full rehab programme post-surgery which is not generally provided. You need to learn to control intra-abdominal pressure, improve breathing patterns, improve posture and gain better mobility and strength to improve pelvic floor function. 

Is there anything you should consider before having surgery? 

Any type of surgery is a huge decision so here are a couple of things you may want to consider:

Age – if you are young, you may need further treatments down the line. The type of surgery you can have when you are older may be dictated by other health conditions and your overall health history. 

If you want more children – if you are looking to grow your family, surgery may not be the right option for you.

Health conditions – there may be other risks to consider if you are living with conditions such as diabetes or heart disease. 

If you haven’t already seen a Women’s Health Physio, make sure you go and get some advice from someone in person. Get your pelvic floor checked for as much support as possible. You can look for a local physio here.

You might be interested in The Pelvic Floor Project if you are interested in improving prolapse symptoms in a holistic and sustainable way.