Pelvic Organ Prolapse (POP) is a common condition affecting women, particularly those who have had children, are postmenopausal, or have experienced pelvic floor strain. It occurs when the supporting muscles and ligaments of the pelvic organs (such as the bladder, uterus, or bowel) become weakened or stretched, causing one or more organs to descend into the vaginal canal. Up to 1 in 3 women who have given birth may experience some form of prolapse, though only about 1 in 9 will need surgery in their lifetime.
There are several types of prolapse:
- Cystocele (bladder into the front vaginal wall)
- Rectocele or Enterocele (bowel into the back wall)
- Uterine prolapse (uterus into the vagina)
- Vault prolapse (after hysterectomy)
Symptoms often include a sensation of vaginal bulging, pelvic pressure, discomfort during intimacy, bladder or bowel dysfunction, and lower back heaviness.
Treatment begins with a thorough clinical evaluation and is tailored to each woman’s symptoms, goals, and medical background. Conservative options include pelvic floor physiotherapy and pessary use, both of which are effective and non-invasive. Pessaries are particularly useful for women wishing to delay or avoid surgery, including those who haven’t completed their family.
For women with moderate to severe symptoms or failed conservative treatment, surgical repair may be considered. Surgical options include:
- Native tissue repair (vaginal or abdominal)
- Laparoscopic or robotic uterine-sparing procedures
- Sacrospinous or uterosacral ligament suspension
- Colpocleisis for women no longer sexually active
Dr Deb Karmakar’s research has highlighted the importance of aligning surgical decisions with patient expectations and fully informed consent. In a 2016 review, he and colleagues emphasized that unmet expectations often stem from inadequate preoperative discussions, particularly regarding outcomes and the risks associated (Karmakar, D., & Dwyer, P. L. (2016). Failure of expectations in vaginal surgery: lack of appropriate consent, goals and expectations of surgery. Current urology reports, 17, 1-7.)
Additionally, Dr Karmakar’s clinical study of 472 women undergoing extraperitoneal uterosacral suspension showed a long-term success rate of 89% for vault support, with low complication rates and minimal need for repeat surgery. This suture-based technique avoids entering the peritoneal cavity and offers a durable solution for post-hysterectomy prolapse (Karmakar, D., Dwyer, P. L., Thomas, E., & Schierlitz, L. (2019). Extraperitoneal uterosacral suspension technique for post hysterectomy apical prolapse in 472 women: results from a longitudinal clinical study. BJOG: An International Journal of Obstetrics & Gynaecology, 126(4), 536-542.).
Surgery for POP is generally safe and effective. Most women recover well and return to regular activity within 4–6 weeks, depending on the procedure. Shared decision-making remains key—your surgeon will help you choose the approach best suited to your lifestyle, medical background, and personal preferences.