Pelvic organ prolapse: physical therapy or surgery?

Pelvic organ prolapse arises when one or more pelvic organs (i.e. bladder, uterus, rectum) descend into the vagina from their normal positions. It can be triggered by a variety of factors, including childbirth, obesity and menopause. Prolapse affects up to 50 percent of women at some point in their lives.

Many women prefer to forgo prolapse surgery and look instead to physical therapy.

Introduced in the 1990s, transvaginal mesh was intended to permanently fix pelvic organ prolapse (POP) and stress urinary incontinence — conditions that typically plague older women after a hysterectomy or menopause. Pelvic prolapse occurs when a woman’s pelvic muscles weaken and the pelvic organs — including the bladder, rectum and uterus — drop into the vagina. SUI occurs when everyday activities place pressure on the bladder. To fix these conditions, a hammock-like piece of synthetic mesh is surgically implanted transvaginally, or through the vagina, to support the pelvic organs.

However, transvaginal mesh has several well-known complications such as organ perforation and erosion. Some of the less severe problems include constipation and urinary incontinence. 

There are a few steps you can take to get started along this path:

1. Understand the Pelvic Floor

The pelvic floor spans the area under the pelvis, and comprises muscle fibers of the coccygeus, levator ani, and relative connective tissue. The pelvic floor separates the perineal region from the pelvic cavity. Please have a look at this article I have already posted.

2. Visit and ask the advice of a Medical Doctor you trust

Always visit a Medical Doctor you trust and ask his advice. It is important for you to get all the required information, examination and testing related to this problem. A trained Medical Doctor, mainly a Urogynecologist, has this knowledge and the experience to help you in this difficult decision.

3. Ask a Physical Therapist

As the MD will probably advise you, exercising your pelvic floor muscles is of the most important things you can do. Find a trained Physical Therapist you trust, give him/her all the required information he/she will ask you and follow his/her treatment plan.

A few exercises a professional may take you through* are:

• Straight leg raises (SLRs)
• Squats
• Posture therapy
• Kegel exercises

Therapists may also use biofeedback. This involves using a monitoring device with sensors placed either on your skin or inside your rectum or vagina. As you perform an exercise, a screen displays the strength of each contraction, as well as whether you’re using the proper muscles.

*Please consult a professional before attempting any of the exercises listed.

4. Consider All Options

Although surgery for prolapse can be the right choice for many women, it can be a last resort for others after they have exhausted alternative treatments. A large reason for avoiding prolapse surgery could be because of the less-than-favorable buzz surrounding transvaginal mesh, a hammock-like polypropylene plastic piece of material implanted through the vagina to support pelvic organs.

Sounds great in theory, right? Sadly, however, this mesh has been eliciting a slew of lawsuits over the complications arising for a number of women who have had it inserted transvaginally. According to the Food and Drug Administration (FDA), these complications have included organ perforation, vaginal erosion, and infection, among others.

If you do require surgery, talk to your doctor about solutions that do not involve transvaginal mesh.

An what does the American Urogynecologic Society say about these?

This article was created by me and Jen Juneau. Jen Jeneau is a content writer for Drugwatch.com. She is versed in technical writing, creative writing and everything in between.