Surgical options for a pelvic organ prolapse include native tissue repair (non-mesh), biological (absorbable) mesh repair and/or a vaginal hysterectomy.

For severe forms of pelvic organ prolapse where the uterus or the vaginal vault slip down from their normal position and protrude outside the vagina, a colpocleisis procedure or a sacrospinous fixation procedure are used.

What are native tissue repairs?

Native tissue procedures are operations that use your own vaginal and pelvic tissues (rather than mesh) to repair and support areas affected by prolapse. The type of repair depends on which part of the vagina or uterus is affected.

Types of native tissue repair

• Anterior vaginal repair (cystocele repair): strengthens the front wall of the vagina to support the bladder

• Posterior vaginal repair (rectocele repair): strengthens the back wall of the vagina to support the bowel

• Perineal body repair (perineorrhaphy): reinforces the tissue between the vagina and back passage (perineum), which can be stretched or weakened after childbirth

• Vaginal hysterectomy: removal of the womb through the vagina, if the prolapse involves the uterus

How are these operations done?

These procedures are usually performed under a general or spinal anaesthetic. Cuts are made inside the vagina, the weakened tissues are repaired and reinforced with slow-absorbable sutures, and the vaginal wall is then closed. If a vaginal hysterectomy is needed, the womb is removed through the same approach.

Common Questions

How effective are these operations?
Most women notice a big improvement in their prolapse symptoms. However, like all prolapse surgery, there is a chance that the prolapse may come back in the future, either in the same place or in another part of the vagina.

What are the risks?
Risks include infection, bleeding, urinary problems, and a small risk of injury to surrounding organs. Some women may develop new urinary symptoms afterwards, such as urgency. Rarely, the repair may not hold as expected and further treatment may be required.

Will it affect sexual function?
Most women find that surgery improves comfort during sex by relieving the bulge and pressure symptoms caused by prolapse. Occasionally, scar tissue or tightening of the vagina may cause discomfort, but this is uncommon.

What is colpocleisis?

Colpocleisis (sometimes called vaginal closure surgery) is an operation used to treat symptoms of uterine, vaginal vault or vaginal wall prolapse.

This procedure is only suitable for women who are not sexually active and who do not wish to be in the future, as the vaginal opening is closed and vaginal intercourse will no longer be possible afterwards..

When is colpocleisis considered?

• Women with medical conditions that make them unsuitable for longer or more complex operations

• Women who have not been able to use a vaginal pessary successfully

• Women who have had prolapse procedures in the past that have not worked

How is the operation done?

Colpocleisis can be performed under local anaesthetic with sedation, a spinal anaesthetic, or a general anaesthetic. During the procedure, a portion of the front and back walls of the vagina is removed and the two walls are stitched together, creating a partial closure of the vagina. This provides support to the prolapsed organs and relieves prolapse symptoms.

At the end of the operation, a cystoscopy (camera test of the bladder) is performed to check that the bladder and ureters (the tubes from the kidneys) are unharmed. A catheter is then placed in the bladder to drain urine, which usually stays in overnight.

Common Questions

How effective is colpocleisis?
Most women find that it relieves the symptoms of prolapse very effectively. Because the vagina is closed, there is little risk of the prolapse coming back.

What are the advantages of this operation?
The procedure is shorter and less invasive than many other prolapse operations, which makes it particularly suitable for women who are frail or have other health problems.

What are the downsides?
The main limitation is that vaginal intercourse is no longer possible. Very rarely, some women may develop new urinary symptoms or discomfort afterwards

What is sacrospinous fixation?

Sacrospinous fixation is a surgical procedure used to treat pelvic organ prolapse. It is a non-mesh procedure that restores support to either the uterus if still present (hysteropexy),  or the vaginal vault if the womb has been removed (colpopexy).

How is the operation done?

The procedure is performed under a general or spinal anaesthetic. Through a cut in the vagina to either the cervix (if present) or the vaginal vault, this is then stitched to a strong ligament in the pelvis called the sacrospinous ligament. The stitches used are slowly absorbed. Over time, they are replaced by natural scar tissue, which continues to support the uterus or vagina long-term.

Sacrospinous fixation can often be carried out at the same time as other operations, such as Vaginal hysterectomy, Anterior (front wall) or posterior (back wall) vaginal repair.

Common Questions

How effective is sacrospinous fixation?
Most women notice a significant improvement in prolapse symptoms. The procedure provides strong long-term support, although, as with all prolapse surgery, there is still a small risk of recurrence.

What are the advantages of this operation?
It avoids the use of mesh, uses a vaginal approach without abdominal cuts, and can be combined with other procedures if needed.

What are the risks?
Risks include infection, bleeding, or pain, particularly in the buttock or leg due to the location of the stitches. In most women this settles with time. A small number may experience urinary difficulties or recurrence of prolapse in a different part of the vagina.

No, some pelvic organ prolapse cases are managed conservatively with physiotherapy or pessaries.

Most surgeries are effective, but recurrence is possible.

Most women stay in hospital for one or two nights. Recovery usually takes 4 to 6 weeks. During this time, you should avoid heavy lifting and strenuous activity, but gentle walking and light daily activities are encouraged.

Most women return to normal function, though changes are possible.