About Incontinence - Treatment / Management Options - Surgery for Pelvic Organ Prolapse (POP)
Medical Reviewer: Karen Sasso, MSN, RN, APN, CCCN
There are several different types of surgeries performed for the treatment of pelvic organ prolapse (POP). The kind of surgery used is dependent on the type of prolapse (bladder, womb or end of vagina, uterine, or bowel) Sometimes, when the patient is experiencing stress urinary incontinence, the surgeon can perform an anti-incontinence surgery, (most likely a loose sling under the neck of the bladder) during the prolapse surgery for treatment of stress urinary incontinence.
There are two main categories of surgery for prolapse: obliterate and reconstructive. In obliterate surgery the vaginal opening is closed completely. While this surgery is less invasive than reconstructive, there is no possibility of intercourse following obliterate surgery. It is done in women who are at surgical risk of complications from the anesthetic or the surgical procedure. Reconstructive surgery, which is much more commonly performed than obliterative surgery, is a longer and more invasive procedure, but the goal is to restore the anatomy, resolve the stress incontinence if present and allow for future intercourse.
Who?
Surgery is performed on women experiencing pelvic organ prolapse, which is often the result of pregnancy and/or childbirth. Any surgery for pelvic organ prolapse is considered major surgery, and the decision should not be taken lightly. Depending on the degree to which you are experiencing prolapse, your health care provider may desire to start with a less-invasive treatment first, such as pelvic floor exercises, biofeedback, and/or use of a pessary (a supportive device for the vagina).
The Pros
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In severe cases of prolapse, surgery may be the only way to find relief from pelvic discomfort and stress incontinence.
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In almost all cases, a skilled surgeon can usually perform reconstructive surgery that will allow for normal sexual function following the recovery period.
The Cons
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A few women may need to have the surgery repeated later in life, especially women who had their initial surgery done at a relatively young age.
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The surgery usually requires general anesthesia and an overnight hospital stay for up to two nights.
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The recovery period after the surgery generally requires no heavy lifting for approximately six to twelve weeks.
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While surgery can fix pelvic organ prolapse, it may not always fix all types of urinary incontinence. This surgery is not intended to resolve urge urinary incontinence.
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In rare cases the surgery can contribute to urinary retention from too tight of a sling. This can be corrected in a minor surgical procedure with local anesthetic and a few hours in the hospital.
Karen Sasso, RN, APN , is the Program Manager and Urogynecology Clinical Nurse Specialist at the Evanston Continence Center at NorthShore University HealthSystem in Evanston , Illinois .
Ms. Sasso received her nursing diploma from the Medical College of Pennsylvania, Philadelphia , Pennsylvania , a Bachelor of Science degree in nursing at Alverno College , Milwaukee , Wisconsin , and a Master of Science in nursing at the University of Wisconsin-Milwaukee .
Her clinical practice involves the evaluation and treatment of women with urinary incontinence, voiding dysfunction, and pelvic floor disorders. She has extensive experience in clinical research for the treatment of women with stress urinary incontinence, detrusor overactivity and genital prolapse.
A regular contributor to the medical press, Ms. Sasso has authored and coauthored a number of articles on female urinary incontinence, genital prolapse and treatment options. Her work has appeared in such journals as Obstetrics and Gynecology, Urologic Nursing, RN, and Wound, Ostomy and Continence Nursing. She has also coauthored a book chapter published in Textbook of Female Urology and Urogynecology. She has presented at numerous symposia within the United States and abroad including the 29th Annual Scientific Meeting of the American Urogynecologic Society in Chicago, Illinois, the Society of Urologic Nurses and Associates Annual Symposium: Disorders of the Bowel, Bladder and Pelvic Floor in New York, NY and the 21st and 25th International Uro-gynecological Association Conferences in Rome, Italy and Vienna, Austria. She is also a reviewer for the journal Urologic Nursing, a committee member for the Wound, Ostomy and Continence Nursing Certification Board and a Project Advisory Council member for the National Association for Continence.
She is certified by the Wound, Ostomy and Continence Nursing Certification Board as a Certified Continence Care Nurse (CCCN) and licensed in the State of Illinois as an Advanced Practice Nurse. Ms. Sasso is a member of the Society of Urologic Nurses and Associates; the American Urogynecologic Society; the Wound, Ostomy and Continence Nurses Society; and the International Urogynecological Association. She was presented with the 2004 Continence Care Champion Award by the National Association for Continence and the Urologic Nursing Journal’s 2006-2007 Literary Excellence Award.
Page last modified 26 July 2009