Pelvic organ prolapse is a common problem which occurs when the bladder, rectum, or small intestine prolapse, or fall, to a varying degree. Many women have mild prolapse without symptoms, and it’s difficult to improve on mild symptoms with surgery. In more severe cases, a patient may complain of pelvic pressure, heaviness, or a pulling sensation. Severe pelvic pain is not usually caused by pelvic organ prolapse and should be investigated by a physician.
In mild cases, observation and pelvic muscle exercises prescribed by a physical therapist are successful. Another conservative treatment option includes a device called a pessary. This small plastic ring is inserted into the vagina above the pelvic muscles and can easily be removed. Many women choose to use this device during exercise only.
Understanding Your Options
Surgical therapies, including the placement of vaginal mesh, are also available to alleviate the symptoms of pelvic organ prolapse.
“In regards to surgical treatments, there is much confusion on whether mesh should be used for support of the pelvic tissues,” Dr. Portera explains. “While most first-time repairs can be done without the vaginal placement of mesh, some patients who have a recurrence or severely weakened tissues, mesh may be necessary for adequate support.”
The Food and Drug Administration has recently issued warnings for certain types of surgical treatments of prolapse that show a significant increase in risk of mesh placed vaginally.
Mesh placed through an incision or with a laparascope (an instrument somewhat like a miniature telescope with a fiber optic system which brings light into the abdomen and allows for minimally invasive surgery) was not included in this warning.
Recently, placing the mesh abdominally has been achieved robotically. A controlled study from the Cleveland Clinic published November 2011 comparing the placement of mesh robotically with conventional laparoscopic placement indicated that the placement of mesh robotically for support was associated with longer operating times and higher cost, while not improving long-term outcomes. Patients considering surgical treatment will want to discuss these factors with their OB/GYN physician. For more information about these warnings, visit FDA.gov, ACOG.org, or AUGS.org.
Choosing a skilled pelvic surgeon, experienced in vaginal, intraabdominal and laparascopic surgery will also help achieve optimal results. It is now well known that more surgical experience leads to better outcomes.
“Before choosing a treatment option, patients should discuss the risks, complications and success rates with their physician.” Dr. Portera advises. “These issues are not lifethreatening and don’t always require treatment, but when properly addressed, the results can provide significant lifestyle improvements.”
J. Chris Portera M.D. is a Gynecologist, Urogynecologist and Reconstructive Pelvic Surgeon at Women's Institute for Specialized Health in Chattanooga, TN.