On Surgical vs. Non-Surgical Treatment for Pelvic Organ Prolapse

 

Pelvic organ prolapse (POP) is a condition that affects many women and is characterized by the descent of pelvic organs due to the weakening of the pelvic floor muscles. POP is a widespread condition, impacting roughly 50% of women, and 12% of American women get surgery for it at some point in their lives. 

The likelihood of experiencing POP increases with age and factors like childbirth, genetics, and chronic strain​. It often leads to discomfort and a host of pelvic floor-related dysfunctions. For those grappling with this condition, the dilemma often revolves around selecting an appropriate treatment method. 

In this article, let us look at some of the advantages and disadvantages of both surgical and non-surgical treatments for POP. Hopefully, understanding the nuances of each approach will help you make the safest choice.

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What is Pelvic Organ Prolapse?  

Pelvic organ prolapse (POP) is a condition that involves the displacement of pelvic organs toward or through the vaginal canal. 

This occurs when the pelvic floor muscles and connective tissues that hold these organs in place become weakened or stretched. Factors contributing to this weakening can include childbirth, the natural aging process, hormonal changes during menopause, obesity, and activities that put pressure on the pelvic muscles, like heavy lifting.

Women with POP might experience a variety of symptoms. Some may feel pressure or fullness in the pelvic area, have a sensation that something is falling out of the vagina, or notice a bulge in the vaginal canal. 

Discomfort during sexual intercourse, lower back pain, urinary problems such as incontinence or a frequent need to urinate, and challenges with bowel movements can also be indicators of POP.

Diagnosing POP generally involves a pelvic examination where a healthcare provider may observe the prolapsed organs. The degree of prolapse is often described in stages, ranging from mild to severe, based on how far the organs have descended. 

In some instances, imaging tests such as ultrasounds or MRIs might be used to gain additional insight into the extent of the prolapse and to plan potential treatments.

 

Surgical Interventions for POP

Surgery is often considered to provide a definitive solution to POP. Treatment aims to restore the pelvic organs to their original position and repair the supportive pelvic floor tissues. The success rate of prolapse surgery is approximately 85 to 95%, though this varies based on the specifics of the case and the individual’s health factors. Some studies indicate a high immediate success rate of 97% and 90% at three months post-discharge.

One common surgical intervention is the use of vaginal mesh, also known as pelvic mesh or transvaginal mesh. This is a synthetic, net-like implant designed to provide additional support to the weakened pelvic floor muscles. 

The use of mesh came under significant scrutiny due to reports of severe complications in some women, including mesh erosion, where the mesh wears through the vaginal wall, chronic pain, infections, urinary problems, and painful intercourse. 

According to TruLaw, many of the women who had these implants were not informed of the complications associated with the surgery. 

As a result of the harm suffered from mesh-related complications, many individuals have pursued legal action and filed vaginal mesh lawsuit cases.  Studies have reported an overall erosion rate of 10.3% and complications such as persistent vaginal bleeding, irregular discharge, and recurrent urinary tract infections.

 

Non-Surgical Management of POP

Non-surgical management of pelvic organ prolapse (POP) offers several routes for women who prefer to avoid surgery or for whom surgery might not be the best option due to health concerns or personal choice. This management focuses on symptom control and aims to improve the quality of life without operative intervention. Lifestyle modifications are often the first line of defense. 

This can involve weight loss for overweight individuals, as the extra weight can place additional strain on pelvic tissues. Advising women to avoid heavy lifting and straining during bowel movements can also help manage the severity of the prolapse. Smoking cessation is encouraged as smoking can lead to a chronic cough, which can worsen POP. 

Pelvic floor physical therapy is a specialized form of physical therapy aimed at strengthening the pelvic floor muscles. A trained therapist can guide women through exercises known as Kegels, which, when done correctly and consistently, can improve the strength and function of the pelvic muscles, providing better support for the pelvic organs.  

Kegel exercises have long been recognized for their effectiveness in managing symptoms of POP. They are known to be particularly beneficial for stress urinary incontinence in women, with cure rates of up to 80% reported.

However, non-surgical treatments may require ongoing commitment and may not be as effective for more advanced cases of POP. Pessaries, for instance, require routine care and may cause discomfort or irritation for some women. Moreover, hormone therapy has associated risks and may not be advised, depending on a woman’s medical history.

 

Conclusion

The choice between surgical intervention and non-surgical management depends on several factors, including the severity of the condition, the individual’s lifestyle, and the tolerance for potential risks and benefits associated with each method. 

For women making this crucial decision, it will be essential to engage in open, thorough discussions with healthcare providers. Being well-informed and supported by a team of experts provides the best platform for making an empowered choice.