Frequently asked questions about pelvic organ prolapse (POP)

Pelvic organ prolapse occurs when muscles and ligaments in the pelvic floor are stretched to become too weak to hold the pelvic organs in the correct position. When this happens, organs such as the bladder, rectum, and uterus can bulge (prolapse) into the vagina and sometimes past the vaginal opening. Potential causes include pregnancy and childbirth, aging and menopause, obesity, pelvic tumors, chronic coughing, chronic constipation, heavy lifting, prior pelvic surgeries, or genetic factors.

Common symptoms of pelvic organ prolapse include:

• Pressure or discomfort in the vaginal or pelvic area, often made worse with physical activities such as prolonged standing, jogging, or bicycling
• Diminished control in the bladder and/or bowels
• A bulge near the opening of the vagina
• Pain during intercourse

Depending on the severity and the type of prolapse, your physician will discuss the available treatment options you may want to consider. An option for mild cases is pelvic floor exercises, such as Kegels, which are intended to increase strength and maintain elasticity in the pelvic muscles. Another treatment option is a pessary, which is a ring-like device placed in the vagina designed to provide support for the organs that have fallen (or prolapsed). Pessaries are typically fitted by healthcare professionals. If symptoms are still bothersome and can’t be managed with a pessary or other non-surgical options, surgery may be needed. Treatment options should be discussed with your physician.

If non-surgical treatments do not provide sufficient relief of your symptoms and your pelvic organ prolapse continues to cause pain, problems with bowel and bladder functions, or if it interferes with your sexual activity, you may choose to discuss surgical options with your doctor.

The goal of any type of surgical treatment for prolapse is to repair the supporting tissue of the prolapsed organ or vaginal wall using either the patient’s own tissues or a surgical mesh. Surgeries can be performed either through the abdomen or the vagina. Surgeries performed via the abdomen may be performed laparoscopically using several small incisions or through one larger abdominal incision. It’s important to discuss your options with your physician to determine which treatment plan is most appropriate for your specific medical situation.

Examples of surgeries for POP:

• Procedures using patients' own tissue to repair the prolapse include Modified McCall culdoplasty, high uterosacral ligament suspension, uterosacral ligament fixation, and sacrospinous ligament fixation.
• Procedures using synthetic mesh to treat prolapse via an abdominal incision include sacrohysteropexy or sacrocolpopexy.
• A hysterectomy, or removal of the uterus, may be recommended by a doctor if a patient is experiencing uterine prolapse (when the uterus prolapses into the vagina)

Synthetic mesh is generally used to help repair weakened or damaged tissue. In urogynecologic procedures, mesh is permanently implanted to reinforce the weakened vaginal wall as part of the prolapse repair.

Some surgical procedures use materials to help facilitate prolapse repair. These may include:

• Synthetic mesh (a medical-grade material)
• Biologic grafts (made from processed human tissue)

These materials are used to help strengthen the vaginal wall and support the affected organs.

As with any surgery, there are potential risks. Potential adverse events associated with implanting synthetic mesh in pelvic organ prolapse procedures can be found below.

Please consult your physician to discuss the associated risk and complications for the specific surgical material you receive. Below is a list of potential adverse events for Boston Scientific’s pelvic organ prolapse surgical material.

Potential adverse events, any of which may be ongoing, include but are not limited to: Abscess (swollen area within the body tissue, containing a buildup of pus), Adhesion formation (when a scar extends from within one area to another), Allergic reaction (hypersensitivity) to the implant, Bleeding, Bruising, Constipation, Dehiscence (opening of the incision after surgery), De novo detrusor instability (involuntary contraction of the bladder wall leading to an urge to urinate), Dyspareunia (pain during sexual intercourse) that may not resolve, Erosion into organs, exposure/extrusion into vagina (when the mesh goes through the vagina into other organs or surrounding tissue), Exposed mesh may cause pain or discomfort to the patient’s partner during intercourse, Fistula formation (a hole/passage that develops through the wall of the organs) which may be acute or chronic, Foreign body reaction (body’s inflammatory response to the implant) which may be acute or chronic, Granulation tissue formation (reddish connective tissue that forms on the surface when a wound is healing), Hematoma formation (a pool of blood under the skin/bruising), Hemorrhage (profuse bleeding), Infection, Inflammation (redness, heat, pain, or swelling at the surgical site as a result of the surgery) which may be acute or chronic, Injury to ureter (the duct that urine passes from the kidneys to the bladder), Mesh contracture (mesh shrinkage), Necrosis (death of living tissue in a small area), Nerve injury (injury to the nerve fiber), Organ perforation (a hole in or damage to these or other tissues that may happen during placement), Pain: pelvic, vaginal, groin/thigh, dyspareunia (which may become severe), Perforation or laceration of vessels, nerves, bladder, or bowel (a hole in or damage to these or other tissues that may happen during placement), Post-operative bowel obstruction (blockage that keeps food or liquid from passing through the small or large intestines), Prolapse/recurrent prolapse (complete failure of the procedure), Scarring/scar contracture (tightening of the scar), Sexual dysfunction (difficulty with sexual response, desire, orgasm, or pain); including the inability to have intercourse, Tissue contracture (tightening of the tissue), Vaginal shortening or stenosis which may result in Dyspareunia and/or Sexual dysfunction, Voiding dysfunction: incontinence, temporary or permanent lower urinary tract obstruction, difficulty urinating, pain with urination, overactive bladder, and retention (involuntary leakage of urine or reduced or complete inability to empty the bladder). The occurrence of one or more of these complications may require treatment or surgical intervention. In some instances, the complication may persist as a permanent condition after the surgical intervention or other treatment. Removal of mesh or correction of mesh-related complications may involve multiple surgeries. Complete removal of mesh may not be possible and additional surgeries may not always fully correct the complications.

As with any procedure, it is difficult to estimate your specific results, but your physician can help by explaining the options available to you and suggesting a treatment plan for your specific medical situation. Your physician will consider a number of factors to determine the likelihood of recurrence in your situation and the appropriate treatment option(s) for you. The ultimate goal is to give you a lasting repair.

Mesh exposure (when mesh becomes visible through surrounding tissue) or erosion (when mesh affects nearby organs) can occur in some cases after pelvic organ prolapse surgery. Treatment of these complications may include additional surgical procedures that may not correct the complication. Your doctor will determine the most appropriate approach based on your individual situation. Surgical mesh exposure and pain may occur years after initial mesh placement, so it's important to continue regular follow-up care with your doctor. 

Yes. You should ask your physician to give you a copy of any patient education information that is available for the specific product used during your surgery, and keep it in your personal file.

Recovery experiences vary for each patient, so it's important to consult with your physician about what to expect in your specific case.

Before being discharged from the hospital, you may receive medication to relieve potential discomfort or possibly be prescribed an antibiotic. Your doctor will also determine the type of anesthesia used and the length of your hospital stay. Your physician will provide instructions on when you can resume moderate or strenuous activities and sexual intercourse. 

Notify your physician immediately if you experience pain with urination, bleeding, painful sexual intercourse, severe pain, defecatory issues, or any other concerning symptoms. Be sure to follow your physician's guidance on which activities to avoid during recovery.

Every patient’s recovery experience is unique, and you should consult with your physician as to what he or she expects in your case. Your doctor will determine which kind of anesthesia will be used during your surgery, the length of time you may be hospitalized after the surgery, your need for additional medication following the surgery (for example antibiotics) and whether you will have to go home with a catheter (a flexible plastic tube that drains urine from your bladder). After undergoing prolapse surgery, you may feel sore. Notify your physician immediately if you have pain with urination, bleeding, painful sexual intercourse, severe pain, defecatory problems, or other problems after surgery.⁹ Please consult with your physician on activities to avoid during recovery.