Patient education: Surgery for pelvic organ prolapse (The Basics)

What is pelvic organ prolapse? — 

This is a condition that affects the "pelvic floor." The pelvic floor is the name for the muscles that support the organs in the pelvis. These organs include the bladder, rectum, and uterus (figure 1).

Pelvic organ prolapse is when these muscles relax too much. This causes the organs to drop down and press against or bulge into the vagina.

There are different types of prolapse, depending on which organs are affected (figure 2):

●If the bladder bulges into the vagina, it is called "cystocele."

●If the rectum bulges into the vagina, it is called "rectocele."

●If the uterus bulges into the vagina, it is called "uterine prolapse."

Some things can increase your risk of having pelvic organ prolapse. They include pregnancy, obesity, and older age.

If you need uterine prolapse surgery, your doctor might talk to you about also getting a "hysterectomy." This is surgery to remove the uterus. That way, it cannot prolapse into your vagina.

How do I prepare for pelvic organ prolapse surgery? — 

The doctor or nurse will tell you if you need to do anything special to prepare.

Before the procedure, your doctor will do an exam. They might send you to get tests, such as:

●Lab tests

●Ultrasound or other imaging tests – These create pictures of the inside of the body.

Your doctor will also ask about your "health history." This involves asking about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes prescription or "over-the-counter" medicines, plus any herbal supplements. It helps to write down and bring a list of your medicines, or bring a bag with all your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●If you need to use an estrogen cream in your vagina before the procedure

●Eating and drinking before the procedure – You might need to "fast" before the procedure. This means not eating or drinking anything for a period of time. Or you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure.

●Lowering the risk of infection – You might need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need someone else to bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during pelvic organ prolapse surgery? — 

When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines to make sure you do not feel pain during the procedure. Types of anesthesia include:

•Regional – This blocks pain in 1 area of your body, such as the lower half of your body. You might be awake. Or you might get "sedative" medicines to help you relax and feel sleepy.

•General – This makes you unconscious so you can't feel, see, or hear anything during the procedure. You might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure. You might also get a bladder catheter to remove urine.

●Pelvic organ prolapse surgery can be done in 3 ways:

•Open surgery – The doctor makes a cut ("incision") in the skin of the belly. This lets them see directly inside the body to do the surgery.

•Minimally invasive surgery – The doctor makes smaller incisions in the belly. They insert long, thin tools through the incisions. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the body. Then, they use the long tools to do the surgery. They can control the tools directly, or with the help of a robot (called "robot-assisted" surgery).

•Vaginal surgery – The doctor makes an incision in the vagina to do the surgery.

●The doctor will use stitches or mesh to give support to the organs that are prolapsing into the vagina.

●They will close your incisions and cover them with clean bandages.

●The surgery usually takes 45 minutes to 4 hours.

What happens after pelvic organ prolapse surgery? — 

You will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. You might be able to go home later that day. Or you might stay in the hospital for 1 to 3 days.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●Depending on which type of surgery you had, your bladder catheter might be removed right after surgery or before you go home from the hospital. Or you might keep the bladder catheter in place for a time after going home.

●You might have gauze packing in your vagina for up to a day. The doctor will remove it before you go home.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine to help with pain, if needed. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of pelvic organ prolapse surgery? — 

Your doctor will talk to you about all the possible risks, and answer your questions.

Possible risks include:

●Problems from surgery, such as bleeding, infection, or a tear in the bladder

●Trouble getting all the urine out when urinating

●Still having stress incontinence after surgery

●Urgency incontinence, also called "urge incontinence" or "overactive bladder syndrome" – This is a feeling of having to urinate all the time or needing to urinate in a hurry. Some people also leak urine if they don't get to the bathroom in time. This can happen after surgery, or can get worse for people who had it before surgery.

●Pain during sex

●Pain in the groin – This is the area where the thigh meets the rest of the body.

What else should I know? — 

Before you go home from the hospital, make sure you know what problems to look out for and when to call the doctor. Make sure you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

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