International Patients’ Guide to Pelvic Organ Prolapse Treatment in India

Pelvic organ prolapse

Pelvic organ prolapse (POP) is a disorder in which one or more of the pelvic organs (bladder, uterus, rectum or small bowel) begin to move out of place and protrude into the vagina. This occurs when supporting muscles and connective tissues in the pelvic floor become weak or get stretched.

Causes and Risk Factors

• Pregnancy and childbirth through the vagina (particularly, multiple or painful births)
• Menopause (because of the lowering of estrogen)
• The old age and muscle weakness in the pelvis.
• Constipation and straining chronic.
• Difficult lifting or coughing.
• Obesity
• Past pelvic surgery (e.g. hysterectomy)

Types of Pelvic Organ Prolapse 

• Cystocele- bulging of the bladder in the anterior vaginal wall.
• Rectocele - the rectum pressing against the wall of the vagina at the rear.
• Enterocele- small intestine falling in the vagina.
• Uterine prolapse- uterus sliding into vaginal canal.
• Vault prolapse - hysterectomized top of the vagina.

Pelvic organ prolapse treatment

The choice of the treatment of pelvic organ prolapse (POP) is determined by the intensity of the symptoms, the nature of the prolapse, the general health, and individual preferences (planned pregnancy). Therapy begins with non-surgical interventions and can proceed on to the surgical aspects of treatment.

Non-surgical treatment options 

• Widest range of prolapse of mild to moderate, patients ineligible to undergo surgery or simply unwish to undergo surgery.

Lifestyle and Self-care

• Pelvic floor exercises (Kegels): Tones up the pelvic muscles; most effective with early prolapse.
• Weight management: Decreases the pelvic pressure.
• Avoid straining: Constipation, avoid heavy lifting.
• Treat persistent cough: To decrease the intra-abdominal pressure.

Pessary Use

• A pessary is a silicone tube which is placed into the vagina to hold organs of the pelvis.
• Variations: Ring, Gellhorn, cube and donut, etc.
• Advantages Non-surgical, reversible, customizable.
• Needs:Cleaning on a regular basis, follow-up to avoid irritation or infection.
• Better option in women who are about to undergo surgery, geriatric patients, or those who desire the fertility preservation.

Hormone Therapy

• Topical estrogen cream/tablets/ring can be used to help in postmenopausal to enhance vaginal tissue elasticity and decrease irritation (not a treatment, but supportive).

Surgical Treatment Options

• Use when moderate to severe prolapse is advised, or when the symptoms are severe enough to affect the quality of life.

Types of Surgery:

• Reconstructive Surgery (repositioning of the organs)
• Anterior repair (colporrhaphy): Repairs a protrusion of the bladder (cystocele).
• Posterior repair (rectocele repair): Repairs rectum being pushed into vagina.
• Sacrocolpopexy: This involves mesh to hold the vagina or uterus and is performed through an abdominal or minimally invasive (laparoscopic/robotic) procedure.
• Sacrospinous fixation or uterosacral ligament suspension: Vaginal surgery to hold the vaginal vault or uterus in place.
• Obliterative Surgery (sealant of the vagina)
• Colpocleisis: Seals the vaginal canal; extremely effective, but in women who desire to continue to be sexually active, not appropriate.
• Mostly in older women who do not want to have intercourse.
• Hysterectomy (in case of uterus prolapsed)
• Vaginal or laparoscopy hysterectomy can be done with prolapse repair.
• In younger women, sometimes uterus preserving surgeries are desirable.

Recovery and Outcomes

• Non-surgical (pessary, exercises): Relief of symptoms immediately, no downtime, but must be maintained.
• Surgical repair: stay in hospital 1 to 3 days (less with less invasive surgery).
• Healing: 4-6 weeks (light activity in 2 weeks).
• Success rate: 70-90 and recurrence may take place.
• Risks: Bleeding, infection, pain, recurrence, urinary problems (in case of use).

Making the Right Treatment Choice

• Mild symptoms: Pelvic floor therapy + lifestyle.
• Mittle grade, no preference of surgery: Pessary + estrogen.
• Extreme symptoms, or pessary intolerable: Surgical repair.
• No sexual activity: older age Obliterative surgery (colpocleisis).

Pelvic organ prolapse surgery in India

Pelvic organ prolapse (POP) operation is indicated in moderate to severe symptoms, when conservative measures (such as pessaries or pelvic floor muscle exercises) do not help or when the prolapse is causing major problems with the quality of life. The aim is to recover normal anatomy, to enhance functioning and to alleviate symptoms.

Types of Pelvic Organ Prolapse Surgery

Reconstructive Surgery:

• Seeks to correct and sustain pelvic organs without disrupting vaginal functioning

Anterior colporrhaphy

• Corrects the cystocele (bladder prolapse) using vagina.
• The tightening of weak tissue of the front vaginal wall takes place.

Posterior colporrhaphy

• Treat repair of rectocele (rectum into vagina).
• Brings strength to back vaginal wall.

Sacrocolpopexy

• Used to repair vaginal vault prolapse (which is common following hysterectomy).
• Vaginal apex to sacrum by mesh or suture.
• May be done either open, laparoscopic or robotic.
• High long-term success rate.

Suture of the uterosacral ligament / Sacrospinous fixation

• Vaginal methods of supporting and hanging the uterus or vaginal vault.
• When uterus is saved it is often selected.

Hysteropexy (uterus-sparing medicine)

• Uterus is raised and elevated (either through vaginal, abdomen or laparoscopy).
• Women have an option of preserving fertility.

Obliterative Surgery:

• Aims to seal or tighten the vagina so it offers support - to women who do not want to have sex

Colpocleisis

• The vagina canal remains sealed and prolapse is not repeated.
• Less risk, shorter operation, very effective.
• Inappropriate when the vaginal intercourse is desired by the woman.

Hysterectomy and Prolapse Repair:

• In case of the prolapsed uterus as such, supportive procedures (e.g., sacrocolpopexy) may be considered in addition to a vaginal or laparoscopic hysterectomy.
• In younger women sometimes uterus-sparing repairs are favored.

Best hospital for pelvic organ prolapse treatment

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Non-surgical treatment for pelvic organ prolapse

Non-surgical treatment of pelvic organ prolapse (POP) is commonly suggested to females with mild to moderate prolapse, those opting to postpone or avoid surgery, or because surgery is contraindicated by other health complications. It aims at alleviating symptoms, enhancing functioning and worsening.

Lifestyle & Self-Care

Pelvic floor (Kegel) exercises

• Make the pelvic muscles stronger and enhance support.
• Best used during the early prolapse or post childbirth.
• Needs to be performed every day (preferably with the assistance of physiotherapy).

Bladder and bowel care

• Prevent constipation (high-fiber food, sufficient fluids, stool softeners as needed).
• Treat chronic cough (quit smoking, lung illnesses).
• Timed urination in order to minimize straining.

Weight management

• Lightens the load to the pelvic floor.
• Do not lift heavy or stand too long.
• Helps slows down prolapse.

Vaginal Pessary

• A silicone gadget that is placed in the vagina to hold the pelvic organs.
• Kinds: ring, Gellhorn, cube, donut, and so on.
• Can relieve bladder, uterine or vaginal vault prolapses.

Benefits:

• Reversible, non-surgical, effective in the relief of symptoms.
• May be used either short-term (until operation) or long-term.

Needs:

• Cleaning (once a week to once a month).
• Gynaecologist follow-up to prevent irritation, discharge or infection.

Hormonal Therapy

• In postmenopausal women, topical estrogen (cream, tablet, or ring) can be of use.
• Enhances strength and elasticity of the vaginal tissue.
• Frequently combined with pessary to minimize the irritation and complications.
• Not curative of prolapse, but serves to relieve the symptoms.

Pelvic Floor Physiotherapy/ Biofeedback

• Correct muscle contractions are taught at special physiotherapy programs.
• Electrical stimulation or biofeedback devices can be used to make it more effective.
• Assists those women who have difficulty with Kegels.

Supportive Measures

• Vaginal lubricants (in case it is dry/irritated).
• Lifestyle changes (exercise changes, posture changes).
• Supportive garments use (in some cases).

Pelvic organ prolapse treatment in India with GetWellGo

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

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• Complete transparency
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• Expert gynaecologists with a strong track record of success
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food