Pelvic organ prolapse (POP) happens when there is a lowering or drop of one of the vaginal compartments. This can happen when the tissues that support the vagina get weak, similar to a hernia.
The bulge that you see is the wall of the vagina. Other structures behind the wall of the vagina can push on it and cause it to drop or stick out. There are different names for prolapse depending on which organ has dropped.
What are the different types of POP?
- Anterior prolapse (cystocele): The bladder has dropped.
- Apical prolapse: The uterus or cervix has dropped. If you've had a hysterectomy, this is called enterocele or small bowel prolapse.
- Posterior prolapse (rectocele): The rectum pushes into the back wall of the vagina. This is not the same as a rectal prolapse, which is when the rectum drops out of the anus.
- Perineal hernia: A bulge in the space between the vagina and the anus. This is often seen with a posterior prolapse.
How is POP treated?
Some amount of prolapse is very common and you may not need treatment if it does not bother you.
Treatment may help if you have:
- Pain in the pelvis or the vagina
- Trouble peeing
- Trouble with bowel movements
- Pain with sex
Common treatment options are:
- A pessary (a device placed in the vagina for support)
- Surgery
Only you and your care team can decide what is the best choice for you.
What are the types of surgery for POP?
Your care team will recommend the options that fits your situation best. It's always okay to ask questions.
- Surgery works well for most people (about 80 to 90 out of 100 people).
- Surgery may last 1 to 5 hours.
- You may stay in the hospital for 1 to 2 nights.
The most common types of surgery are abdominal repair, vaginal repair, and closing the vagina.
Abdominal repair
This is usually done using:
- Robotic or laparoscopic surgery: Uses small cuts and a camera.
- Sacrocolpopexy: Mesh is used to attach the wall of the vagina to the lower part of the spine.
- A hysterectomy: Removes the uterus. This is the preferred choice to fix a prolapse. It is successful for about 90 out of 100 people.
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Vaginal repair
For most people, the cuts are made on the wall of the vagina. Types of vaginal repair include:
- A hysterectomy with:
- Uterine suspension
- Apical suspension
- Sacrospinous ligament fixation (SSLF)
- Anterior repair (supports the bladder)
- Enterocele repair (reduces the small bowel at the top)
- Posterior repair (supports the rectum)
- Perineorrhaphy (supports the spot between the vagina and anus)
- Possible use of donor tissue for the graft.
- A sling procedure to stop stress incontinence.
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Closing the vagina
This surgery closes the vagina completely.
- It cannot be undone.
- It usually takes about 1 hour.
- You will stay in the hospital for 1 night.
Good for patients who:
- Are over 70 years old.
- Are not having sex.
- Do not want to have sex again.
Advantages:
- Works well for 95 out of 100 people, even with severe prolapse.
- Does not require the provider to go into the pelvis or abdomen.
- Does not need a hysterectomy.