Before we step into today’s topic, here’s a quick four‑sentence refresher from last week’s column. Pelvic organ prolapse happens when the bladder, uterus or bowel slips down and bulges into the vagina, usually because the pelvic floor has weakened over time.
Many women experience symptoms like heaviness, dragging pain or a visible bulge, but prolapse is not dangerous and often manageable. Treatment ranges from lifestyle changes and pelvic‑floor exercises to vaginal pessaries. Surgery is considered when symptoms interfere with daily life or when other options haven’t helped enough.
Pelvic organ prolapse is a condition that quietly affects millions of women, especially after childbirth and menopause. For some, simple measures like physiotherapy or pessaries offer good relief. But for others, the discomfort becomes a daily companion — affecting mobility, confidence, intimacy and even the ability to work. When symptoms persist, surgery becomes an option worth exploring. This column aims to demystify prolapse surgery in clear, practical language, helping women and families make informed decisions.
When does surgery enter the picture?
Surgery is not the first step for prolapse — and it doesn’t need to be. But it becomes relevant when:
• The vaginal bulge is large or bothersome
• Bladder or bowel symptoms interfere with routine activities
• Pelvic‑floor exercises and pessaries haven’t helped
• The prolapse affects sexual comfort or confidence
Your doctor will look at your age, general health, type of prolapse and future pregnancy plans before recommending surgery. Women who plan more children are usually advised to wait, because pregnancy and childbirth can undo the repair.
Understanding the surgical options
Prolapse surgery is not one single operation — it’s a family of procedures, each designed for a specific problem. Most surgeries are done through the vagina, though some require keyhole or abdominal cuts. Here are the main types, explained simply:
• Pelvic floor repair — The vaginal walls are tightened and reinforced to support the bladder or rectum. This is the most common surgery and is done through the vagina.
• Vaginal hysterectomy — If the uterus has dropped significantly, removing it may help. Often combined with pelvic floor repair. Usually done vaginally, without abdominal cuts.
• Sacrocolpopexy — A mesh or tissue graft is used to lift the top of the vagina and attach it to the spine. Done through keyhole or abdominal surgery. It offers strong, long‑lasting support.
• Sacrospinous fixation — Instead of mesh, stitches are used to anchor the vagina to a strong pelvic ligament. Done through the vagina. Recovery is quicker, but buttock pain can occur temporarily.
• Sacrohysteropexy — Similar to sacrocolpopexy, but the uterus is preserved and lifted using mesh.
• Colpocleisis — The vagina is partially or fully closed to support the organs. This is a low‑risk option for older women or those who no longer desire vaginal intercourse.
Sometimes, surgery for urinary leakage is added during prolapse repair, depending on symptoms.
The mesh question: What women should know
Mesh has been a topic of debate worldwide. Synthetic mesh can offer strong support, but it also carries higher risks. Up to 1 in 10 women may experience mesh erosion — where the mesh wears through the vaginal wall. This can cause pain, discharge, bleeding or discomfort during sex. Rarely, mesh can erode into the bladder or bowel.
Mesh complications can be difficult to fully correct, and removal is not always possible. Because of this, many surgeons now prefer non‑mesh options when suitable. The choice depends on your anatomy, symptoms and medical history.
Benefits you can expect
Women often report:
• Relief from heaviness and dragging
• Better bladder or bowel control
• Improved comfort during daily activities
• Renewed confidence in movement and intimacy
Some surgeries offer longer‑lasting results than others, and your doctor will guide you on what to expect.
Risks you should be aware of
Every surgery carries risks, and prolapse surgery is no exception. Common issues include:
• Bleeding
• Infection
• Pain during intercourse
• Recurrence of prolapse
Some women may continue to have bladder symptoms, or develop new ones like difficulty passing urine.
Less common risks include:
• Injury to bladder or bowel
• Blood clots
• Pelvic abscess
For vault prolapse (prolapse after hysterectomy), sacrocolpopexy and sacrospinous fixation have different pros and cons. Sacrocolpopexy has lower recurrence and fewer urinary issues, while sacrospinous fixation avoids mesh and offers quicker recovery. Buttock pain after sacrospinous fixation is common but usually settles within three months.
Recovery: What real life looks like
Hospital stay varies from one to three days, depending on the procedure. Most women can walk the next day. But healing takes time — and patience.
Doctors usually advise:
• No heavy lifting for several weeks
• No sexual intercourse for 6–8 weeks
• Avoiding constipation
• Gentle walking to improve circulation
Support at home makes a big difference. Many women underestimate how much strain daily chores place on the pelvic floor.
How successful is surgery?
Surgery improves symptoms for most women, but no operation can guarantee a permanent cure. Around 25–30 per cent may develop prolapse again in the future — sometimes in a different part of the vagina.
The risk is higher if you are overweight, constipated, have a chronic cough or do heavy physical work. Lifestyle changes remain important even after surgery.
Making the decision: A shared journey
Choosing surgery is not a one‑line decision. It is a conversation — between you, your doctor and your family. Women often find it helpful to write down questions before their appointment.
Start with these three:
• What are my options?
• What are the pros and cons for me?
• How can I get support to make the right decision?
Prolapse is a deeply personal condition, but you are not alone. With the right information and guidance, most women find a treatment plan that restores comfort, confidence and quality of life.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
