Pelvic Organ Prolapse (POP)

When the muscles and ligaments supporting a woman’s pelvic organs weaken, the pelvic organs can drop lower in the pelvis, creating a bulge in the vagina (prolapse). Women most commonly develop pelvic organ prolapse years after childbirth, after a hysterectomy or after menopause.

Treatments vary according to the type and severity of the problems and the patient’s goals. Some problems can be managed without surgery—with medication, pelvic floor therapy, and core strengthening exercises, or the use of a medical device called a pessary that the patient can insert and remove herself to support areas of pelvic prolapse.

Candidates for surgical repair of pelvic organ prolapse (POP) have usually tried more conservative management. The type of surgery recommended depends on the site of the prolapse, the presence of urinary or fecal continence, the patient’s age and general health, her desire to remain sexually active, and her personal preferences.

POP surgery can be reconstructive, which aims to correct the prolapse and restore normal anatomy, or obliterative, which corrects prolapse by removing or closing off a portion of the vaginal canal. Obliterative surgery is an option for women who can’t tolerate more extensive surgery and/or don’t plan to be sexually active.

Most women with POP have reconstructive surgery. This can be performed abdominally or vaginally, depending on the type of repair needed. Some reconstructive surgery may include the implantation of surgical mesh, a woven fabric made of biologic or synthetic materials. Your surgeon will use the woven material to create a hammock-like support for the prolapsed organs and surgically anchors the mesh to muscles or ligaments. Over time, the patient’s tissues grow over the mesh, which stabilizes it in its supportive position.