Study Should Ease Menopausal Women's Fears About Pelvic Prolapse Surgery

Dorian Martin Health Guide
  • Menopause comes with all sorts of changes to the body. One change that some women experience but can’t see is a pelvic organ prolapse. This condition is caused by a change in their pelvic floor function. In this situation, at least one organ that’s located in the pelvic area – the bladder, vagina, small bowel, rectum, urethra or uterus – moves from where it should be.


    Pelvic organ prolapse can be caused by a variety of issues (including heavy lifting and a hysterectomy). However, decreased estrogen levels that accompany the menopausal transition can cause the muscles, ligaments and tissue that hold up the pelvic organs to atrophy, thus causing the organs to drop. Menopause also can be the time when an initial prolapse that initially started during a vaginal childbirth becomes evident.  Approximately 3 percent of U.S. women will experience symptoms of prolapse annually.

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    The symptoms of pelvic organ prolapse can include:

    • Feeling pain or pressure in either the pelvis or vagina.
    • Feeling like something is emerging from the vagina.
    • Seeing tissue protruding from the vagina.
    • Having difficulty urinating.
    • Feeling that your bladder will not totally empty when urinating.
    • Having difficulty with bowel movements.
    • Having lower back pain.
    • Experiencing incontinence when you sneeze, cough or exert yourself.
    • Having frequent bladder infections.
    • Experiencing pain when having sexual intercourse.

    Initial treatments include low-dose estrogen therapy, which helps strengthen the vaginal structures that support the pelvic floor, or use of a pessary, which is a device that is placed into the vagina and holds various organs in place. Surgery is also an option in more severe cases. In fact, approximately 300,000 surgeries to correct pelvic organ prolapse are performed annually in the United States.

     

    So are these surgeries effective? A new study looked at two types of surgical procedures – sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) – that are commonly performed to treat prolapse. A ULS procedure involves the surgeon stitching the vagina to the uterosacral ligaments, which usually connect the lower portion of the womb to the tailbone. The SSLF procedure involves the surgeon stitching the top of the vagina to a sacrosphinous ligament, which links the lower tailbone to the pelvis.


    The researchers also looked at perioperative behavioral therapy with pelvic floor muscle training (BPMT) to see if it helps improve the outcome of prolapse surgery. This therapy involved one pre-surgical session and four sessions spread over the 12 weeks after surgery. Participants received coaching on how to do exercises that focused on muscle contractions designed to strengthen the pelvic floor muscles.


    This study involved 374 women who underwent surgery to treat apical vaginal prolapse as well as stress urinary incontinence between 2008 and 2013. Almost all of the study participants also had additional surgical procedures, such as a hysterectomy,  at the same time based on their symptoms. The women a were given standard instructions prior to surgery, which included eating a high-fiber diet, avoiding heavy lifting, and not having sexual intercourse.  The women participated in periodic follow-ups with researchers over a two-year period following their surgery.


  • The researchers found similar success rates among women who had the SSLF procedure and those who had the ULS procedure. Furthermore, the researchers found that less than five percent of the women in either group had serious adverse outcomes that were directly related to the procedure.

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    Interestingly, BPMT wasn’t associated with improved urinary symptoms. The researchers didn’t find any significant difference in incontinence, prolapse and discomfort between women who participated in the exercise program and those who received regular care.


    Primary Resources for This Sharepost:


    Barber, M. D., et al. (2014). Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: The OPTIMAL randomized trial. JAMA.


    National Institutes of Health. (2014). Two surgeries for pelvic prolapse found similarly effective, safe.


    University of Colorado Urogynecology. (ND). Menopause & prolapse.

Published On: March 17, 2014