Pelvic organ prolapse (POP) is seldom as simple as pelvic floor muscle weakness, connective tissue damage, nerve damage, or displaced organs; it’s often woman’s unique combination of these structural concerns. While as women we may have multiple common denominators, every one of us brings a somewhat unique blend of physical damage and lifestyle impact to the plate.
The POP dynamic is a complex one. Realistically if surgery for pelvic organ prolapse was easy, everyone would do it. But it’s not easy. And it’s not logical for everyone to jump to surgery at the first opportunity. Show me a woman who is not sure about moving forward with POP surgery and I’ll show you a woman who should spend more time experimenting with non-surgical treatment options. The right time to move forward with POP surgery is a very personal decision that few women are comfortable with immediately after POP diagnosis. Everyone heading into surgery has fear; being sure you want surgery is not about being fear-free, it’s about recognizing that you are not happy with the results non-surgical options have provided, and feeling comfortable moving forward.
While trying to understand their pelvic organ prolapse diagnosis and treatment options, some women will seek guidance from a single POP specialist. Others seek counsel with multiple practitioners. As with other health concerns, practitioners often have different suggestions for treatment. When making the difficult decision which treatment is the best option, women struggle; how is it possible to figure out the best treatment choice for POP when practitioners often disagree on what the that treatment should be? Fear and frustration abound in the pelvic organ prolapse dynamic; we all want to feel good, and to live our lives to the fullest, and who wants to have major surgery?
So how do we choose the best treatment option? If non-surgical treatments are your choice, a urogynecologist will often fit a pessary, a vaginally inserted device that supports the pelvic organs. Additionally a women’s health physical therapist can guide you through a multitude of treatment options such as pelvic floor and core exercises, myofascial release therapy, biofeedback, or electric stimulation.
If surgery is your treatment of choice, the question may become to mesh or not to mesh. If mesh is used, there is much to sift through to understand the difference between polypropylene, cadaver tissue, biologic, or native tissue repair, and to better evaluate the safest and most effective choice. The dialogue then turns to which is the best approach. Vaginal, abdominal, laparoscopic, and robotic procedures are all surgical technique options, and within those choices are subsets of approaches.
I’ve had surgery for three types of POP (cystocele, rectocele, and enterocele, grade three), and yes after intense Q&A sessions with my urogynecologist, I opted to have transvaginal mesh. In the six plus years since my surgery, I have not regretted the decision for a moment. Do I know what will happen to my body six, ten, or twenty years down the road? Of course not; I recognize that every surgery comes with risk, and much still needs to be researched and recognized in the POP arena. The bottom line is I made the right choice for me at the time I needed to make the decision. That does not mean my choice would be the right choice for every woman, and there seldom is an “easy” choice. We all want to be the best we can be and navigate the least risk factor. But at the end of the day, we must take some calculated risks based on the guidance we receive from our specialists and the research currently available.
My suggestion for women is pretty basic. Each woman suffering from the physical, emotional, social, and sexual ramifications of POP needs to dig and dig deep. Step one if you suspect you have POP is to seek an official POP screening and diagnosis from a practitioner who specializes in POP such as a Female Pelvic Medicine Reconstructive Surgery (PFMRS) urogynecologist or urologist, to determine exactly which of the five types of POP you have and what grade of severity is occurring. A qualified POP practitioner is going to give you options; take the info they share and do your homework ladies!