Pelvic Organ Prolapse (POP) Treatment Options

Prolapse treatment options may vary depending on the type of prolapse. The treatment will depend on the severity of the condition as well as your general health, age, and desire to have children.

Nonsurgical options for POP may include:

Exercise — Special exercises, called Kegel exercises, can help strengthen the pelvic floor muscles. This may be the only treatment needed in mild cases of prolapse. For Kegel exercises to be effective, they need to be done daily.

Vaginal pessary — A pessary is a rubber or plastic device used to support the pelvic floor and maintain support of the prolapsed organ. A health care provider will fit and insert the pessary, which must be cleaned frequently and removed before sexual intercourse.

There are 2 approaches to surgical treatment for POP1:

  • Reconstructive (surgery to restore normal anatomy)
  • Obliterative (surgery to close the vagina completely)

Reconstructive surgical options include1:

  • Vaginal colporrhaphy and apical suspensions using native tissues
  • Sacral colpopexy
  • Transvaginal mesh (TVM) repair kits

The goal of surgical POP treatments is to repair or correct the prolapse.1

Surgical options are used to help return prolapsed organs to a more normal anatomical position and to strengthen structures around the prolapsed area to maintain support.1

Depending on your needs and the procedure performed, your doctor may choose a graft made from either a synthetic mesh or a biologic material to repair the prolapse and restore your anatomy.

Elevate® Prolapse Repair System

Typically, procedures to correct prolapse take place on an in-patient basis and are performed under general anesthesia. It is possible for your doctor to repair more than one type of prolapse during the same surgery.2

Clinical studies have shown that 91% to 96% of patients felt that their prolapse symptoms were somewhat or greatly improved following surgery with Elevate®.3,4

Elevate® is designed to:

  • Offer a minimally invasive solution
  • Minimize tissue trauma
  • Restore normal anatomy with a faster recovery than open abdominal approaches
  • Minimize pain compared with more invasive procedures

Depending on the type of prolapse you are experiencing, the Elevate procedure will, in general, follow these steps2:

  • A small vaginal incision is made
  • The mesh is inserted through an incision and placed in the body
  • The mesh is secured in the body through the use of self-fixating tips attached to the mesh that are inserted into the ligament or muscles to secure the mesh until natural tissue ingrowth occurs
  • The incision is closed

Your hospital stay will be determined by your doctor. Incisions will be small and should heal quickly so, depending on the nature of your work, you may be able to return to work after one to two weeks. However, you will need to refrain from sexual intercourse, heavy lifting, and rigorous exercise for six to eight weeks to allow your body to heal. Your doctor will provide you with additional information on how to care for yourself after surgery.

Is It Right For You?

Sling procedures require surgery and are not recommended for everyone, especially if you are pregnant or have blood coagulation disorders, a compromised immune system, renal insufficiency, or upper urinary tract obstruction. Do not undergo this surgery if you have known sensitivity or allergy to polypropylene mesh products. Inflammation and irritation may occur after surgery. If you are planning future pregnancies, you should consult with your physician as future pregnancies may negate the effects of the surgical procedure. You should talk with your doctor about benefits and risks before moving forward with any treatment option.

Risks and precautions

Mesh is a permanent medical device implant. The safety and effectiveness of mesh or film support in transvaginal surgical procedures to treat pelvic organ prolapse have not been evaluated in a prospective, clinical study comparing it with native tissue repair. You should carefully discuss the warnings and precautions with your doctor before you decide to undergo a procedure to implant mesh to treat this condition.

Click here to find a list of helpful questions to ask.

Risk Information

As with most surgical procedures, potential adverse reactions may occur. Some potential adverse reactions to prolapse repair procedures include:

  • Adhesion formation (scar tissue)
  • Mild to severe bleeding (hematoma, perforation of vessels)
  • Constipation
  • Complete failure of the procedure resulting in recurrent POP
  • Dyspareunia (pain during intercourse)
  • De novo prolapse of an untreated compartment
  • Urinary incontinence
  • Fecal incontinence
  • Foreign body (allergic) reaction to mesh implant
  • Infection
  • Mesh erosion (presence of suture or mesh material within the organs surrounding the vagina)
  • Mesh extrusion (presence of suture or mesh material within the vagina)
  • Mesh migration
  • Nerve damage
  • Obstruction of ureter
  • Pain/discomfort/irritation
  • Perforation (or tearing) of vessels, nerves, bladder, ureter, colon, and other pelvic floor structures
  • Urinary tract infection
  • Vaginal contracture (mesh shortening due to scar tissue)
  • Voiding dysfunction (difficulty with urination or bowel movements)

NOTE: Some of these adverse reactions are specific to procedures involving mesh repair (e.g., mesh extrusion).

References:

  1. Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet. 2007;369(9566):1027-1038.
  2. References available upon request.
  3. Lukban JC, VanDrie D, Rovers JP, Moore RD, Nguyen JNK, Lange R. Long Term Results of Elevate Apical and Posterior for Vaginal Wall Prolapse Repair. J Minimally Invas Gyn. 2011;18(Suppl 6):S53.
  4. Stanford E, Moore R, Rovers JP, Lukban J, Bataller E, Sutherland S. Elevate anterior/apical: safety and efficacy in surgical treatment of pelvic organ prolapse. Neurourol Urodyn. 2011;30(6).

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Mesh — a surgical material used since 1968

It can be reassuring to learn that the use of mesh for reinforcement has been used extensively in surgery since 1968. Since that time, surgical mesh has been used in more than 1 million patients worldwide.

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