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Do I Have To Have Surgery if I Have Prolapse?

Hi friends! You’ve felt a bulging in the shower one day. You went to have it checked by your physician and they diagnosed you with pelvic organ prolapse (POP). They are recommending surgery and you aren’t sure what to do. Does this sound familiar? Being diagnosed with POP can be scary, but know you are not alone!


Remember that this is not medical advice and is solely intended to be educational. Only you and your provider can make the decision of what is best for you.


POP is a condition in which one or more of the pelvic organs begins to fall into the vaginal canal. It is staged from one to four based on the severity; with stage one being the least, and stage four being the most, severe.


Potential risk factors for POP include: (Bo, 2015)

  • Constipation

  • Pelvic surgery

  • Pregnancy and vaginal delivery

  • Genetic factors

  • COPD

  • Heavy work/exercise


“Watchful waiting” is recommended for POP that are stages one, two, or three if symptoms are not severe because they may improve (Bo, 2015). This means that if symptoms do not impact the quality of life, it is recommended to treat conservatively unless symptoms become severe. Surgery to repair POP may be indicated if pelvic pain is present, if there is difficulty performing daily activities, or if conservative management has not been successful.


What does conservative management entail? Conservative management of POP may include pelvic floor muscle training, lifestyle modifications, and/or the use of a pessary. Some research has shown that pessary use can help to improve or prevent worsening of prolapse symptoms (Bo, 2015)


A pelvic therapist can assist in teaching proper pelvic floor muscle training exercising and the bracing/knack technique can help to prevent and treat POP symptoms (Bo, 2015). In addition, a pelvic floor therapist can address issues like constipation that affect the pelvic floor muscles and increase the risk of POP.


What if you decide that surgery is the right option for you? There is a high incidence of new compartment prolapse and recurrent POP after surgery (Bo, 2015). Seeing a pelvic floor therapist for pelvic floor muscle training and lifestyle modifications may compliment surgical repair (Bo, 2015). While there is conflicting research on the benefits of therapy after surgery compared with surgery alone, it is recommended since it does not have side effects and may improve results.


Regardless of your decision to have surgery, it is a personal decision and should be made by you and your providers. Many people live happy lives with POP and you can, too!


Here are some great resources to help you learn more about your POP:


For providers, check our online courses to help your clients. Consider joining our Ambassador Program and most of our courses are included with your membership!


Written by Emily Reul, PT, DPT


References

1. Bo K, Berghmans B, Morkved S, Van Kampen M. Evidenced-based physical therapy for the pelvic floor bridging science and clinical practice. 2nd edition. 2015. 230-242.

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