The pelvic floor is made up of pelvic muscles, ligaments, connective tissues, nerves and arteries. It contains organs such as the rectum, uterus, vagina, and bladder. Several factors such as vaginal birth, trauma during childbirth, repeated lifting of heavy objects and chronic disease or surgery may weaken or stretch the pelvic floor. When the pelvic floor can no longer hold the pelvic organs in place, the pelvic organs come down and bulge into the vagina. This condition is referred as pelvic organ prolapse. Pregnancy and child birth are the most important risk factors for prolapse. Pelvic organ prolapse is asymptomatic in most patients. However, in a small percentage of patients it causes symptoms that vary from vaginal discomfort to difficulties in sexual, urinary and defecatory activities.
Asymptomatic patients do not require treatment. Symptoms in most of the symptomatic patients can usually be managed by pelvic floor exercises and use of removable vaginal inserts (pessaries). In rare cases, when even after conservative treatment the symptoms are unmanageable and result in significant impairment of the quality of life of the patient, surgery is advised. The aim of the surgery is to correct the prolapse and maintain urinary and faecal continence and preserve coital and reproductive function.
Pelvic organ prolapse was traditionally treated surgically using native vaginal tissue (NT). It involved the use of the patient’s own tissue and sutures to restore the vagina to a natural position by reattaching it to the various supportive structures. Reports in the literature of high recurrence rates associated with vaginal native tissue repair led to the development of alternative techniques, such as synthetic mesh.
However, the newer current data obtained from large population studies with long term follow up periods show that the recurrence rate with NT is much lower than was earlier predicted. Native tissue repairs have similar outcomes to synthetic mesh without the risks inherent in mesh use. The most common complication associated with mesh repair is erosion or protrusion of the mesh from the soft tissues in the vaginal wall leading to discomfort in intercourse and blood spotting and may require additional surgery. Thus, newer isn’t always better. Native vaginal tissue repair is still the standard of care for the typical patient with pelvic organ prolapse.
Surgery for pelvic organ prolapse is optional. Decision about the surgery should be made only after proper discussion of the risks and benefits of the possible procedure with your urogynecologist.