What is Prolapse Surgery?

Pelvic organ prolapse is a condition that occurs when the muscles and tissues supporting the pelvic organs weaken, allowing one or more of these organs (such as the bladder, uterus, or rectum) to drop or press into the vaginal area. Prolapse surgery is a procedure designed to correct this issue and restore the proper position of the organs.

In many cases, prolapse is caused by factors like childbirth, aging, menopause, or heavy lifting. While some women manage mild symptoms with non-surgical treatments, severe cases may require surgery for relief and to prevent further complications.

Types of Prolapse Surgery

There are several types of prolapse surgeries depending on which organ is affected. Here’s an overview of the most common ones:

• Anterior Vaginal Repair: This surgery corrects cystocele, a condition where the bladder bulges into the vaginal wall. The surgeon tightens the vaginal wall tissue to reinforce support.
• Posterior Vaginal Repair: This is used for rectocele, where the rectum bulges into the vagina. The procedure involves tightening the connective tissue between the vagina and rectum.
• Uterine Prolapse Surgery: If the uterus sags into the vagina, a hysterectomy (removal of the uterus) or uterine suspension (repositioning the uterus) may be recommended. Uterine suspension can be performed using mesh or the patient's own tissues.
• Sacral Colpopexy: This procedure is often used to correct prolapse in women who have had a hysterectomy. It involves attaching the top of the vagina to the sacrum (the base of the spine) using surgical mesh to hold it in place.
• Vaginal Mesh Repair: In cases of severe prolapse, surgical mesh may be used to reinforce weakened tissues. However, this procedure has faced scrutiny due to potential complications, so it’s important to discuss risks with your doctor.

Each type of surgery aims to restore the structure and function of the pelvic organs, relieve discomfort, and improve quality of life. It is essential to understand the specifics of each surgery to determine which one is appropriate for your condition.

When is Prolapse Surgery Necessary?

Prolapse surgery is typically considered when non-surgical treatments, like pelvic floor exercises or pessaries, have failed to improve symptoms, or when the prolapse is causing severe discomfort, pain, or other significant complications. Here are a few reasons surgery may be recommended:

• Severe Symptoms: If the prolapse is causing significant pain, discomfort, or interference with daily activities, surgery might be necessary. Symptoms such as pelvic pressure, urinary incontinence, or difficulty with bowel movements can worsen if left untreated.
• Quality of Life: Women experiencing embarrassment or anxiety due to visible bulging or difficulty controlling bladder or bowel movements may find that surgery significantly improves their quality of life.
• Failure of Non-Surgical Treatments: When non-invasive treatments such as pelvic floor exercises, pessaries, or lifestyle changes fail to provide relief, surgery becomes a more viable option.
• Progression of the Condition: Prolapse can worsen over time. Surgery may be recommended to prevent further deterioration and to avoid complications such as urinary retention, repeated bladder infections, or damage to nearby organs.

How Does Prolapse Surgery Work?

Prolapse surgery can be performed using different techniques. Some of the most common include:

• Laparoscopic Surgery: Minimally invasive, this technique involves small incisions in the abdomen. A camera and surgical tools are inserted to perform the repair. This method generally leads to shorter recovery times and less post-operative pain.
• Vaginal Surgery: In this method, the surgery is performed through the vagina, with no external incisions. It’s commonly used for prolapses of the uterus or vaginal walls.
• Robotic-Assisted Surgery: A more advanced, minimally invasive technique, robotic surgery allows for greater precision and control, making it an effective option for certain types of prolapse repair.

Each surgical approach has its benefits and risks. Recovery times, potential complications, and success rates vary, depending on the type of surgery and the individual patient’s condition.

Is Prolapse Surgery Right for You?

The decision to undergo prolapse surgery should be based on a thorough discussion with your healthcare provider. It’s important to weigh the benefits of surgery—such as relief from symptoms and improved quality of life—against the risks, such as potential complications or a prolonged recovery period.

In many cases, women who undergo prolapse surgery experience significant improvements in their symptoms and overall quality of life. However, some procedures, such as those involving mesh, may carry higher risks, including infection or the need for additional surgeries down the line.

Costs Associated with Prolapse Surgery

When considering prolapse surgery, one common factor patients are worried about is the cost. Surgery can be expensive, and the total cost depends on various elements like the type of procedure, the hospital or clinic you choose, and your insurance coverage. Understanding these costs upfront will help you plan better and avoid surprises later in your treatment journey.

Breakdown of Typical Costs

The total cost of prolapse surgery can vary widely, but here’s a basic estimated breakdown of what to expect:

1. Hospital and Facility Fees:
• This includes the cost of using the operating room, any pre-operative tests, and post-operative care.
• Hospital fees typically range from $10,000 to $30,000 depending on the location and the complexity of the surgery.
• If you choose an outpatient surgical center, the costs may be lower, ranging from $5,000 to $15,000.
2. Surgeon’s Fees:
• Surgeons charge for their expertise in performing the operation, and their fees can vary significantly based on experience, location, and the type of procedure.
• On average, surgeon’s fees range from $2,000 to $10,000.
• More specialized or minimally invasive procedures, such as robotic-assisted surgery, tend to be more expensive due to the advanced technology required.
3. Anesthesia Fees:
• The type of anesthesia used will also affect the cost. General anesthesia (where you're completely asleep) is more expensive than local anesthesia (numbing only the area of surgery).
• Anesthesia fees typically range from $1,000 to $3,000.
4. Post-Operative Care:
• After surgery, you may need follow-up visits, physical therapy, or medication to manage pain or prevent infection.
• Post-operative care costs can add another $500 to $2,000 to your total.

Factors that Affect the Cost of Prolapse Surgery

Several factors influence the final cost the prolapse surgery:

• Type of Surgery: Minimally invasive surgeries, like laparoscopic or robotic-assisted procedures, tend to cost more upfront but may reduce hospital stay and recovery time, lowering post-op costs. More complex surgeries or the use of surgical mesh may also increase the total cost.
• Location: The cost of healthcare can vary significantly by region. Hospitals in larger metropolitan areas tend to charge more than those in rural areas.
• Hospital vs. Outpatient Surgical Centers: Surgeries performed in a hospital typically cost more than those done at outpatient centers. Some prolapse surgeries, especially minimally invasive ones, can be performed as outpatient procedures, which may reduce costs.
• Complications: If there are complications during or after surgery, such as infections or the need for additional procedures, this can increase the overall cost.

Insurance Coverage for Prolapse Surgery

Health insurance plays a significant role in determining how much of the surgery cost you’ll need to pay out of pocket. Here’s how insurance generally handles prolapse surgery:

• Private Insurance: Most insurance plans cover prolapse surgery if it’s deemed medically necessary. However, coverage varies by provider and plan, so it’s important to check with your insurer beforehand. They may cover a large portion of the surgery but require you to pay deductibles, co-pays, or coinsurance.
• Medicare: If you’re covered by Medicare, it usually covers prolapse surgery if it’s medically necessary. However, like private insurance, you will still be responsible for part of the cost, such as a deductible or co-pay. Medicare generally doesn’t cover certain types of mesh used in prolapse surgeries due to safety concerns, so it’s important to check the specific coverage for the procedure recommended for you.
• Uninsured Costs: If you don’t have insurance, you’ll need to pay the full cost out of pocket. This can be a significant expense, ranging from $10,000 to $50,000 or more, depending on the surgery and facility. In such cases, many hospitals and surgical centers offer payment plans or financial assistance to help manage costs.

Long-Term Costs

While the immediate costs of prolapse surgery can be high, it’s also important to consider potential long-term costs:

1. Follow-Up Visits: After surgery, you will likely need several follow-up visits to monitor your recovery and ensure there are no complications. These visits are often covered by insurance but could add to your out-of-pocket expenses if you’re uninsured.
2. Physical Therapy: Many women benefit from pelvic floor physical therapy after surgery to strengthen the muscles and prevent future prolapse. This is sometimes covered by insurance, but if not, it could add another $100 to $200 per session.
3. Potential Complications: Though prolapse surgeries are generally safe, there’s always the possibility of complications like infection, mesh erosion, or recurrent prolapse, which could require additional surgery. Each additional procedure comes with its own costs, so it’s important to discuss these risks with your doctor and plan accordingly.

Alternatives to Prolapse Surgery

Surgery is not the only option for managing pelvic organ prolapse. Depending on the severity of the symptoms, there are several non-surgical alternatives that can effectively manage the condition and improve your quality of life. These options often work best for mild to moderate prolapse or for women who wish to delay or avoid surgery. Before opting for surgery, it’s important to explore these alternatives to determine whether they could be a viable solution for your individual situation.

Non-Surgical Options for Prolapse Management

1. Pelvic Floor Physical Therapy
• One of the most effective non-surgical treatments for prolapse is pelvic floor physical therapy. This therapy focuses on strengthening the muscles that support the pelvic organs, which can help alleviate prolapse symptoms and prevent the condition from worsening.
• How it works: A physical therapist will teach you exercises, often referred to as Kegel exercises, that strengthen the pelvic floor muscles. These exercises help reduce symptoms like pressure and discomfort by improving the support system for your pelvic organs.
• Benefits:
• Non-invasive and low-risk.
• Can be done at home with proper guidance.
• Helps with urinary incontinence, a common prolapse symptom.
• Considerations: Success depends on consistency, and results may take several weeks or months to appear. This approach is more effective in mild to moderate cases of prolapse.
2. Pessary Use
• A pessary is a medical device inserted into the vagina to help support the pelvic organs. Pessaries come in various shapes and sizes, and your doctor or healthcare provider will fit you for one that suits your specific needs.
• How it works: The pessary provides physical support to the organs that have prolapsed, preventing them from further descending into the vaginal canal. It’s a removable device, so it can be cleaned and reused regularly.
• Benefits:
• Can be used as a long-term alternative or a temporary solution before surgery.
• Non-invasive and doesn’t require any recovery time.
• May be particularly helpful for women who aren’t ready for surgery due to age, health concerns, or pregnancy.
• Considerations: A pessary must be properly fitted, and regular cleaning and follow-ups with a healthcare provider are essential to avoid infections or discomfort. Unfortunately, some women are not able to be fitted for pessary use due to their body’s anatomy. In addition, women may experience vaginal irritation, discomfort, odor, or discharge from prolonged pessary use.
3. Lifestyle Changes
• Certain lifestyle modifications can help manage prolapse symptoms and may slow the progression of the condition. These changes focus on reducing pressure on the pelvic organs and strengthening the muscles that support them.
• Dietary changes:
• A high-fiber diet can prevent constipation and straining during bowel movements, which can worsen prolapse symptoms.
• Staying hydrated and avoiding foods that can cause bloating or constipation is crucial.
• Weight management: Maintaining a healthy weight can reduce excess pressure on the pelvic organs, which helps in managing prolapse symptoms.
• Exercise modifications: Avoid heavy lifting and high-impact activities that can strain the pelvic floor. Low-impact exercises like swimming, walking, or yoga are excellent alternatives that don’t put excessive strain on the pelvic area.
• Benefits:
• Low cost and accessible.
• Improves overall health in addition to prolapse management.
• Considerations: These changes can improve symptoms, but may not fully reverse prolapse or provide enough support for severe cases.
4. Medications and Hormone Therapy
• In some cases, medications or hormone therapies may be recommended to manage prolapse symptoms, particularly for women going through menopause.
• Estrogen Therapy: Since menopause leads to a decrease in estrogen levels, the tissues of the pelvic floor may weaken. Estrogen therapy, often administered as vaginal creams, rings, or tablets, can help strengthen these tissues and reduce symptoms of prolapse.
• Benefits:
• Non-invasive and easy to use.
• Can improve vaginal dryness and discomfort in post-menopausal women.
• Considerations: Hormone therapy may not be suitable for everyone, particularly women with certain health conditions (like breast cancer or a history of blood clots). It’s important to consult your healthcare provider to weigh the risks and benefits.

When Are Alternatives Recommended Over Surgery?

Non-surgical alternatives are often recommended in the following scenarios:

• Mild to Moderate Prolapse: If the prolapse is not severe, alternatives like pelvic floor exercises, pessaries, and lifestyle changes can be effective at managing symptoms without surgery.
• High-Risk Patients: If you have other health conditions that make surgery risky, non-surgical alternatives can help manage symptoms safely. For example, women with heart conditions, obesity, or respiratory issues may be better suited for conservative treatments.
• Pregnancy: If you’re planning to have children or are currently pregnant, surgery may not be the best option. Non-surgical treatments can manage prolapse until after childbirth, when surgery can be reconsidered if needed.
• Delay in Surgery: Some women may prefer to delay surgery for personal reasons, such as timing, finances, or recovery concerns. Non-surgical alternatives can provide relief in the meantime.

Using External Supportive Devices for Prolapse

For women dealing with pelvic organ prolapse, supportive devices like prolapse belts can offer immediate relief from discomfort and help manage the condition without invasive procedures. These belts provide external support to the pelvic region, lifting and supporting organs that have descended. External supportive devices, often referred to as prolapse support belts, are designed to provide additional support to the pelvic organs, helping alleviate the pressure caused by prolapse. These belts are a non-surgical solution aimed at reducing symptoms like bulging, discomfort, and pelvic pressure.

Types of Prolapse Support Belts

• Pelvic Support Belts: These are the most common type of prolapse support belts, specifically designed to provide targeted support to the pelvic organs. They lift and hold the organs in place, reducing the sensation of “dropping” that many women with prolapse experience. These belts are suitable for conditions such as uterine prolapse, cystocele (bladder prolapse), and rectocele (rectal prolapse).
• Hernia Support Belts: While primarily used for hernia management, these belts can also be helpful for women with pelvic organ prolapse, as they provide external support to the abdominal and pelvic muscles, relieving pressure on the pelvic organs.
• Maternity Support Belts: During pregnancy, increased abdominal pressure can lead to or worsen prolapse. Maternity belts are designed to support the growing belly and alleviate pressure on the pelvic organs, making them useful for managing prolapse during pregnancy.

Benefits of Using Prolapse Support Belts

• Immediate Symptom Relief: Prolapse belts can provide instant relief from common symptoms like pelvic pressure, discomfort, and a sensation of bulging or heaviness. By lifting the prolapsed organs, the belt helps reduce the strain on surrounding tissues.
• Non-Invasive: Belts offer a non-surgical solution to managing prolapse. For women who are not ready for surgery, they provide an effective, low-risk alternative.
• Adjustable for Comfort: Most prolapse belts are adjustable, allowing you to customize the fit for comfort and mobility throughout the day. Whether you're standing, walking, or sitting, the belt can provide support without restricting movement.
• Helps with Daily Activities: Wearing a prolapse belt can make it easier to perform daily activities that might otherwise aggravate prolapse symptoms, such as walking or standing for long periods.

When to Use a Support Belt

Prolapse support belts are most useful in the following situations:

• Early-Stage or Mild Prolapse: If the prolapse is mild, a support belt can help manage symptoms effectively without the need for surgery. The belt provides external support, reducing pressure on the pelvic organs.
• During Physical Activity or Lifting: If you engage in physical activities that involve heavy lifting or prolonged standing, a prolapse belt can help prevent your symptoms from worsening. It supports the pelvic area and reduces the strain caused by these activities.
• Post-Surgery Recovery: After prolapse surgery, some women may benefit from wearing a support belt to reduce pressure on the surgical site and aid in recovery. The belt can provide additional comfort while your body heals.
• During Pregnancy: For women experiencing prolapse during pregnancy, maternity support belts can help relieve the additional pressure caused by the growing baby. These belts are specifically designed to accommodate the changing body shape during pregnancy.

FemiCushion for Prolapse Support

There are many prolapse support belts on the market, but what sets FemiCushion apart is its inclusion of a silicone cushion that provides direct support to the prolapsed organs. This innovative design offers gentle yet effective support to the pelvic region by preventing the prolapsed organ from slipping out of place. It helps alleviate common prolapse symptoms such as pelvic pain, pressure, and the sensation of bulging. FemiCushion is recommended for women who are not suitable for pessary use or prefer to avoid surgery. It is also highly beneficial when sitting for extended periods, traveling, or recovering from surgery. With FemiCushion, women with prolapse can find non-invasive, practical relief, enhancing their quality of life and overall comfort.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.