All About Prolapse Surgery: Pros & Cons

June 9, 2022
Pelvic Floor

doctor getting ready for a pelvic prolapse surgery

Prolapse Surgery, Pros, Cons & Natural Alternatives

People fear what they don’t understand. For instance, consider “perimenopause”.

It’s easy to panic when your period goes erratic along with unusual symptoms. You might even think that it’s a result of some health condition. But instead it’s really perimenopause — or at least this is a strong possibility and something that often gets overlooked.

After all, perimenopause remains a mystery to the masses. Yet, there’s a World’s Perimenopause Day on October 11. You’re not alone if this is your first time hearing of this!

And this is exactly what this blog is for! We will unveil the truth about the not-so-mysterious perimenopause bleeding and your most pressing question — how long is too long, for a period during perimenopause?

Types of Pelvic Organ Prolapse
(POP)

Prolapse happens when one or more pelvic organs (bladder, rectum, small intestine) descend from their normal positions, causing a bulge and discomfort from the vagina or anus.

There are four types of prolapse based on the area where the condition occurs:

1. Cystocele / Urethrocele

When the protrusion affects the front part (anterior) of the vagina and bladder, the condition is called a Cystocele or Urethrocele.

• Cystocele (bladder)- the bladder drops into the vagina often resulting in urinary incontinence.

• Urethrocele (urethra)- the urethra protrudes into your vagina.

• Cystourethrocele (bladder and urethra)- both the bladder prolapse (cystocele) and urethra prolapse (urethrocele) are present.

2. Rectocele

When the back part (posterior) of the vagina and rectum are involved, it is called Rectocele.

• Rectocele (rectum) – the rectum bulges into the vagina.

• Rectal Prolapse – Rectal prolapse is not the same as a rectocele. Rectal prolapse occurs when the rectum protrudes or prolapses through the anus instead of the vagina.

3. Enterocele

When the anterior vaginal wall and small bowel are involved, this condition is called an Enterocele.

• Enterocele (small intestine) – the small intestine bulges
into the vagina.

• Vaginal Vault Prolapse (top of the vagina) – the top of the vagina loses its support and drops. Your vagina could also turn inside out and fall through the vaginal opening in severe cases.

• Vaginal Prolapse (vagina) – the vagina itself droops until it protrudes from the body. Ligaments, muscles, and skin around the vagina may look like it’s sinking or falling out.

4. Uterine

When the muscles and ligaments of the pelvic floor stretch and weaken, no longer providing enough support for the uterus, Uterine Prolapse occurs.

• Uterine Prolapse (uterus) – the uterus drops down or protrudes out the vagina.

What is Prolapse Surgery going to do for you?

There’s a lot at stake if you decide to have surgery because every surgery no matter how small or invasive is foreign and creates trauma within the body. Your body might reject the surgery, but even if it does accept the surgery, unknown changes can occur in your body.

Factors to Consider Before Surgery

Here are some things to assess before deciding to undergo an operation:

• Age – when you’ve had surgery at a young age, there’s a risk that a prolapse will return. But regardless of age, here are some alternatives that can help reverse your condition.

• Knowledge about prolapse – know your condition and options first before signing that informed consent. Surgery is often the last resort when all other methods fail to alleviate symptoms.

• High cost – surgeries cost thousands of dollars.

• Childbearing plans – a repaired prolapse may return during childbirth, so it’s best to hold off on the surgery if you’re still planning to have children.

• Health conditions and medical history – women with comorbidities and previous pelvic-related surgeries face higher risks.

• Your level of bother – your prolapse might be worrying you when you start to experience more and more symptoms. Do your research first, seek help from professionals, and ask for a second opinion, so you can make an informed choice.

• Your expectations about the surgery – each patient reacts differently to surgery. Manage your expectations and discuss all possible outcomes with your doctor.

• Preference and capabilities of your surgeon – it’s best to ask your surgeon about any specialized training they’ve had in the surgical treatment of POP and overall patient experiences before taking the leap.

• Length of recovery – you will need some weeks off (as advised by your doctor) after surgery. This phase is very important to maximize the benefits of the operation, so refrain from doing strenuous activities. Also, working from home is highly recommended.

2 Types of Surgery for Prolapse

Pelvic floor reconstruction techniques have had mixed opinions and success rates in the field of gynecology and urology until today.

In general, these surgeries can be classified into two types:

1. Obliterative Surgery

This type of surgery narrows and shortens the vagina to support the pelvic organs. While this is the quickest and least risky surgery, sexual intercourse won’t be possible after the operation.

There are two types of obliterative surgery:

• Colpectomy (complete) – closes the vaginal opening completely.
• Colpocleisis (partial) – the vaginal walls are stitched together to repair vaginal vault prolapse.

2. Reconstructive Surgery

This method works by restoring the pelvic organs to their original position. Your doctor will perform a specific type of reconstructive surgery via an open or laparoscopic, abdominal, or vaginal route.

The most common types of reconstructive surgery include:

For Anterior Vaginal Prolapse (front)

• Anterior Colporrhaphy

This is a treatment option for women with a cystocele (bladder prolapse). It aims to strengthen and tighten the connective tissue between the bladder and vagina to lift and support the bladder.

2. For Posterior Vaginal Prolapse (back)

• Posterior Colporrhaphy

This surgery is suggested for women with rectoceles (rectum prolapse). It works through strengthening and tightening the connective tissue between the vagina and rectum to lift and support the area responsible for bowel movement.

3. For Surgery of Apical Prolapse (top)

• Sacrocolpopexy & Sacrocolpoperineopexy

Sacrocolpopexy is used to repair vaginal vault prolapse by attaching the top of the vagina to the coccyx (tail bone found at the bottom of the spine) using synthetic mesh. It is usually performed laparoscopically (through small incisions, or cuts).

Sacrocolpoperineopexy, on the other hand, uses these same techniques but also repairs the perineal body and posterior vaginal compartment.

• Sacrospinous ligament fixation & Uterosacral ligament suspension

This is another option for prolapse in the middle of the pelvic floor. To do this, your doctor will make a cut in the vagina so it can be attached to a strong ligament inside the pelvis. This procedure can also be done along with other prolapse surgeries.

• Sacrohysteropexy

This procedure aims to correct uterine prolapse by attaching the cervix without removing the womb. Aside from being able to spare the uterus, some women choose this surgery over hysterectomy because it has a shorter operating time, blood loss, mesh-related complications, and surgical costs.

• Hysterectomy

This procedure is widely used by women who have uterine prolapse. It works by removing the uterus (womb), disabling you from getting pregnant or having periods after the surgery. If you’re a young adult, however, it’s worth noting that early menopause may put you at greater health risks such as cardiovascular and neurological diseases, among others.

Other surgical treatment alternatives include native tissue repair, biological graft repair, pubovaginal sling, colposuspension, transvaginal mesh, and bulking agents.

Note: In 2019, the FDA ordered manufacturers and distributors of vaginal mesh to stop its distribution due to its ineffectiveness.

Rather than taking a gamble with surgery, try a curated program that includes safe, and 100% natural methods and techniques, where 92% of the participants report a drastic reduction of symptoms in just 12 short weeks.

Pros & Cons of Pelvic Organ Prolapse Surgery

Let us help you by stating all the Pros & Cons you can expect from a Prolapse Surgery.

A. Pros

• Improved Position of Pelvic Organs – surgeries are expected to fix the position of displaced organs (although, you might have more than two surgeries depending on the severity of your condition or a second surgery if the prolapse returns).

• No More Pessary – these devices are usually suggested by doctors until a patient decides to have surgery. If you had trouble wearing these devices, surgery will free you from the hassle of using them.

• Favorable studies on surgery success and quality of life (QoL) –
this one’s double-sided. Although some prolapse surgeries are successful according to studies and show an improved QoL among patients, there is also a high failure rate and lack of data available according to other studies. This makes it difficult to look at prolapse surgeries objectively.

B. Cons

• Risks, Complications, and Recurrence – prolapse surgeries aren’t guaranteed cures. Just like other operations, there’s a chance you could develop mild to severe complications or recurrence depending on the type of surgery, your lifestyle post-surgery, and the effectiveness of the surgery itself.

• Long Recovery Period – women are expected to rest and avoid strenuous activities anywhere from 6 weeks to 2.5 months. If you’re a mother, you might need to arrange how the chores, children, and your job will be taken care of while recovering.

• High Cost – prolapse surgeries usually cost around $5,000 to $9,000 depending on the type, medical provider, and additional medications needed.

• Inability to Have Intercourse for Obliterative Surgery – this method closes off part or all of the vagina. So if you’re still sexually active, this surgery is off the table.

C. Life after Prolapse Surgery
If you decide to have surgery, here’s what you can expect.

Outcomes of POP Surgery

There are various definitions of what constitutes a successful surgery, but they are mostly based on anatomic, symptomatic, and retreatment outcomes.

In one study, researchers noted a high failure rate of up to 61.5%. They also noted that some prolapse surgeries have been commonly performed despite insufficient efficacy data.

In addition, some patients believed their prolapse surgery “worked” because it gave them relief of certain symptoms — despite the high failure rates noted by their surgeons.

In his editorial, Mickey M. Karram, MD (an internationally-renowned urogynecologist and pelvic surgeon) criticized the lack of standardized instruments to assess prolapse accurately and little data on why prolapse surgeries fail. In his words:

“While the literature is replete with new techniques and modifications that show excellent outcomes, in reality, this is not the case.”

What’s the primary reason for this lack of information on failed prolapse surgeries? In short, surgeons are hesitant to publish bad outcomes about their operations.

D. Possible Prolapse Surgery Complications & Risks

Minor symptoms should subside a few weeks after the operation. If they persist, talk to your doctor to clarify what is needed.

Complications can vary from general to specific symptoms including:

– Pain and discomfort during sex
– Bladder problems
– Pelvic pain during and after recovery
– Infection of the surgical site (wound)
– Recurrence of pelvic prolapse
– Other serious problems such as:

• Nerve damage
• Blood clots
• Vaginal scarring
• Infection
• Organ perforation
• Neuromuscular problems
• Vaginal shrinkage (via scar tissue)

Natural Treatments for Pelvic Organ Prolapse

Due to a lack of information on prolapse and its natural healing methods, women are led to believe that surgeries are the optimal way to resolve their condition.

But this notion is pure fiction!

There are a handful of safer alternatives for women who are suffering from prolapse.

Here’s what we recommend:

• Hypopressives
• Pelvic floor relaxation
• Scar Tissue Remediation
• Belly Dancing
• Healthy Diet
• Essential Oils
• Vaginal Steaming
• Meditation
• Visualization and Affirmation

What about Kegels and Pessaries, you ask?

Actually, we have mixed feelings about these methods. Both can provide temporary relief yet they don’t solve the root cause of prolapse. Kegels are not suitable for women with tight pelvic floors while pessaries are invasive devices with their own drawbacks!

Can You Heal Prolapse Naturally Even if You are Older?