You, the patient, must decide along with your physician whether or not to have surgery for your bladder, bowel and/or prolapse problems. Every patient's situation is different.

You and your urogynecologist can create a plan that works best for you. This depends, in large part, on your individual problems. Women typically seek treatment whenever theyr symptoms have negative a impact on their lives. Uncontrollable urine leakage, while common, is not something you just have to 'learn to live with it.' Seeking medical help does not mean that you have to have surgery right away. Some women start with conservative treatment like physical therapy. Some later choose surgery; others do not. 

Depending on the experience and training of your urogynecologist and the exact nature of your problem, various non-surgical or surgical options may be appropriate. No single operation is perfect for every patient. Some surgical options for various types of prolapse are listed below. Your examination, preferences, expectations, and general medical condition must be considered when choosing among surgical options.

Sometimes, the examination in the operating room is slightly different than the office examination. If so, your urogynecologist may decide to add a procedure during or possibly not do something previously planned. Surgery to correct urine leakage is often performed along with prolapse surgery. 

There are two main categories of prolapse surgery: 1) Reconstructive and 2) Obliterative.

Reconstructive Surgeries

The goal of all reconstructive surgery is to restore normal anatomy with or without performing a hysterectomy while giving the patient her best chance at normal quality of life including vaginal intercourse. The most important part of a prolapse repair is to restore the support of the top of the vagina. Three common procedures that do this are the sacral colpopexy, uterosacral ligament fixation, and sacrospinous ligament fixation. Repairing an enterocele is often part of these operations.

Anterior repairs (anterior colporrhaphies) correct cystocele (anterior/front of the vagina).

Rectocele repairs (posterior coloprrhaphies) correct rectoceles (posterior/back of the vagina).

Surgery for uterine prolapse is similar to the ones mentioned above for repairing the top of the vagina. They can all be performed with or without the uterus in place. You and your doctor should discuss the reasons for and against hysterectomy at the time of prolapse surgery.

Obliterative Surgeries

Obliterative surgery closes vagina completely. These procedures are very effective in getting rid of prolapse, but vaginal intercourse is no longer possible. Women must be certain that they no longer want to have intercourse before having one of these operations. These surgeries are typically less invasive and quicker than reconstructive surgery.

Recovery

The hospital stay usually lasts one to three days. Many women have difficulty urinating immediately after surgery and have to go home with a catheter in place to drain the bladder. These catheters are usually necessary for only 3 - 7 days. Prescriptions for pain medicine will be provided. After surgery, patients should “take it easy” for 6 weeks to allow proper healing. This means no lifting more than 8 pounds (the weight of a gallon of milk), no vaginal intercourse, and no exercise other than walking.

The amount of time necessary for you to "bounce back" from surgery varies by patient and type of surgery. If an abdominal incision is necessary, you will probably have more pain than if your procedure is performed laparoscopically or vaginally. However, some patients are not good candidates for the vaginal or laparoscopic approaches. Again, you and your doctor should discuss this.

Recovery should not be taken lightly. Proper healing is important for good long-term surgical results. This is true even for minimally-invasive prolapse and incontinence surgery.

Outcomes

The goal of continence or pelvic reconstructive surgery is to restore normal anatomy permanently. None of these procedures are successful all of the time. According to the medical literature, failures occur in approximately 5 - 30% of women who have prolapse surgery. If this occurs, it is usually a partial failure requiring no treatment, pessary use, or less extensive surgery. Patients who follow recommended activity restrictions for at least 6 weeks after surgery give themselves the best chance for success.

If you are going to have surgery to correct prolapse, bladder testing (called urodynamics) may be indicated. That's because the prolapsed portion of your vagina may be pushing on your urethra and preventing urine leakage. If so, correcting the prolapse can give you a new problem - urinary incontinence. 

If left untreated, pelvic organ prolapse either gets worse or stays the same. The one exception to that rule can occur shortly after having a baby. This will often get better within the first year after the delivery.

Treatment of prolapse should be based on your symptoms. In rare cases, severe prolapse can cause urinary retention that progresses to kidney damage or infection, When this occurs, prolapse treatment is necessary. Otherwise, patients should decide when to have their prolapse treated, based on how much they are bothered by it.

Operations for prolapse and incontinence can be performed with or without a hysterectomy. Hysterectomy is often performed along with these operations for a variety of reasons. In some cases, removing the uterus first makes the rest of the surgery easier. In other cases, there is another reason, such as excessive bleeding, to remove the uterus.