What Is Pelvic Organ Prolapse?
Gene Huebner, M.D., OB/GYN
Surgical treatment of POP is aimed at allowing patients to return to their previous level of activity.
Pelvic organ prolapse (POP) occurs when one or more pelvic organs (the uterus, urethra, rectum or bladder) shift downward and bulge into or out of the vagina. Though this condition was rarely discussed or recognized in the past, it has recently become a priority in women's health care. It is estimated that POP affects nearly 50 percent of women.
POP is thought to be caused by the stretching or tearing of pelvic muscles due to pregnancy, childbirth, obesity, menopause, heavy lifting or coughing, aging or genetically determined tissue weakness. It can also occur after hysterectomy. Patients may notice a mass or protrusion along with pelvic pressure, low back pain, urinary incontinence or retention, constipation or involuntary loss of stool, vaginal spotting, bleeding or difficulty with sex (pain or physical hindrance).
Treatment Choices
"There is a limited choice of nonsurgical treatment options for prolapse," says Gene Huebner, M.D., OB/GYN, Chairman of the Perinatal Department at Methodist Sugar Land Hospital. "For minimal symptoms, a woman may choose to do nothing or can be fitted with a pessary — a plastic device used to lift the pelvic floor. However, surgical repair will be required for most cases of POP."
Surgical treatment of POP is aimed at allowing patients to return to their previous level of activity, improving sex and eliminating the unpredictability of loss of urine or stool. There is not one type of surgery that is appropriate for everyone. You and your physician should decide on an individualized treatment plan depending on your stage of prolapse, your complaints, and most important, your preferences. There are several types of surgical techniques available. Some require a hysterectomy, while others do not. The objective of the operative procedures (whether done through a vaginal, abdominal or laparoscopic incision) is to restore the support of the apex or top of the vagina and the vaginal walls.
New Techniques Offer Better Outcomes
Unfortunately, traditional treatments have resulted in failure or recurrence in more than 29 percent of cases. However, several new minimally invasive techniques (using a vaginal approach) have been developed to improve the outcome of these procedures, including the placement of synthetic mesh or biological graft material between the vaginal lining and the wall of the bladder and/or rectum. These grafts can be attached to anchoring points in the pelvis to suspend the vagina and prevent future prolapse.
"These new procedures have minimized tissue trauma and nearly eliminated post-operative pain as compared to the earlier, more invasive approaches," Dr. Huebner says. "The end result: normal anatomy and function are restored with a more rapid recovery." In addition, long-term success appears to be comparable to earlier, more complicated procedures. As with any surgical procedure, there are risks and complications associated with this surgery. These risks, however, are minimized when compared to the risk of failure and need for re-operation using older techniques.
If you believe you have significant symptoms of pelvic organ prolapse, schedule an appointment with Dr. Huebner or an OB/GYN in your area by calling 281-274-7500 for a physician referral.
