Uterine Prolapse: Does Every Prolapse Need Surgery?

Pelvic organ prolapse is when the uterus, the bladder, the bowel or — in women who have had a hysterectomy — the top of the vagina moves downwards because its supporting tissues have weakened.

Women often describe it as “a bulge down below”, “like sitting on a ball” or “having to push it back to go to the toilet”. Childbirth, the menopause, long-term constipation, a chronic cough and excess weight all play a part in the weakening.

No. Some women have a degree of prolapse on examination but no symptoms, and they are not operated on.

The decision depends on how much the symptoms limit daily life, whether they affect emptying of the bladder or bowel, and what the woman herself expects.

In mild and moderate prolapse, pelvic floor physiotherapy, losing weight, treating constipation and lifting less can ease the symptoms.

A pessary is a support ring placed in the vagina. For women who do not want surgery, or for whom anaesthesia carries a high risk, it can also be a long-term solution; it needs regular checks and cleaning.

Operations that lift the uterus or vaginal vault attach a supporting mesh to a fixed point. In the classic sacrocolpopexy, this point is the tissue over the front of the spine. Pectopexy is a keyhole (laparoscopic) method that attaches the suspension to the strong ligament on the side wall of the pelvis (the iliopectineal ligament).

The difference has a practical meaning. The area in front of the spine is a narrow space next to large blood vessels, the ureter and the last part of the large bowel. Pectopexy does not enter this area, so it avoids problems arising from those neighbours, and constipation is not expected to get worse after surgery.

An honest limit should also be stated: pectopexy is a newer method, and its long-term comparative evidence is not as broad as that for sacrocolpopexy. The right question is not “which is better” but “which balance suits me”.

Prolapse and urinary leakage are not the same thing. In some women, the prolapse kinks the urethra and hides leakage; once the prolapse is corrected, leakage can appear.

Before surgery, the prolapse is therefore pushed back and a leakage test is done. If needed, a sling is added in the same operation or planned for later. If this step is skipped, an unexpected leakage problem can follow the operation.

In suitable cases, pectopexy can be done while keeping the uterus. Whether it is removed depends on the type of prolapse, any other gynaecological problem and the woman’s own preference, and is decided together.

Plan to stay in Türkiye for around seven to ten days. A check-up examination is done here, so book your flight home for after it. Straining and heavy lifting put direct stress on the repair in the first weeks, so arrange help with your luggage on the way home.

Send your gynaecological examination notes and any POP-Q measurement, urodynamic results, reports of previous operations (especially a hysterectomy), a recent urine test and a list of your medicines.

In the first weeks, heavy lifting, straining and long periods of standing are avoided; preventing constipation matters most in this period. Most women return to desk work within two to four weeks, and a return to sexual activity is usually discussed after six weeks and a check-up.

No repair can guarantee a permanent result; prolapse can recur over the years, in the same or another compartment. The mesh is a permanent implant and can rarely cause pain or become exposed through the vaginal wall; these risks should be discussed before surgery.

This article is general information and does not replace medical advice.