Prolapse Surgery: Fixing the Support System
Hearing the word surgery can make prolapse suddenly feel much scarier than it actually is.
For many people, prolapse never requires surgery at all. But when symptoms are severe, persistent, or interfering with daily life, surgery can be a very effective option. The confusing part is that there isn’t just one prolapse surgery — there are many, and they’re designed to do different things.
This article walks through what prolapse surgery is actually doing, the main surgical options, and to help you decide which approach makes sense for you.
The Goal of Prolapse Surgery
Prolapse surgery is not about “taking everything out.” It’s about restoring support.
Surgeons aim to:
- lift prolapsed organs back into a more normal position
- reinforce weakened ligaments or connective tissue
- improve symptoms like pressure, bulging, and difficulty with bladder or bowel function
- restore normal sexual function (if desired)
Different surgeries achieve this in different ways, which is why no single procedure is right for everyone.
Uterine-Sparing Surgery vs. Hysterectomy
One of the most common questions patients ask is: “Do I need a hysterectomy to fix prolapse?”
The answer is: not always.
Uterine-sparing surgery:
- keeps the uterus in place
- may be preferred for personal, cultural, or anatomical reasons
- can be effective in appropriately selected patients
Hysterectomy-based repair:
- removes the uterus and then supports the vaginal apex
- may be preferred if the uterus itself is contributing to prolapse
- may be recommended if there are other uterine issues (fibroids, abnormal bleeding, cancer risk)
- eliminates the future risk of uterine cancer
Neither option is “better” across the board. The decision is individualized and should reflect both medical factors and patient goals.
Vaginal vs. Abdominal Approaches
Prolapse surgery can be performed through:
The vagina:
- no abdominal incisions
- often shorter recovery
- typically uses native tissue (no mesh)
- slightly higher recurrence rates in some repairs
The abdomen (open, laparoscopic, or robotic):
- allows for attachment to stronger support structures
- often used for sacrocolpopexy
- typically involves mesh
- longer operative time, but excellent long-term durability
Neither route is inherently correct — they’re just different, with different pros and cons (more on this below).
Mesh vs. No Mesh: What That Actually Means
This is one of the biggest sources of anxiety around prolapse surgery - and understandably so.
Mesh refers to a synthetic material used to reinforce pelvic support, similar to mesh used in hernia repairs.
Important clarifications:
- mesh is not used in all prolapse surgeries
- mesh placed through the abdomen has a very different risk profile than mesh placed through the vagina
- vaginal mesh for prolapse repair is no longer routinely used in the U.S. due to known complications
In modern prolapse surgery:
- abdominal sacrocolpopexy often uses mesh and has strong long-term durability
- vaginal repairs typically use the patient’s own tissue (no mesh)
Mesh can improve durability in certain surgeries, but it also carries risks like erosion, pain, or infection. Whether mesh is appropriate depends on anatomy, prior surgeries, recurrence risk, and patient preference.
Common Types of Prolapse Surgery (What’s Actually Being Done)
Sacrocolpopexy:
- performed through the abdomen (usually using a minimally invasive approach)
- attaches the vagina or uterus to the sacrum (tailbone)
- often uses mesh
- considered one of the most durable repairs
Sacrospinous ligament suspension:
- vaginal approach
- attaches the vagina or cervix to a pelvic ligament
- uses native tissue (no mesh)
- common, effective option, but generally less durable than sacrocolpopexy
Uterosacral ligament suspension:
- vaginal or abdominal approach
- uses existing uterosacral ligaments for support
- uses native tissue (no mesh)
- often performed at the time of hysterectomy
Anterior and posterior colporrhaphy:
- repairs the front (bladder) or back (rectal) vaginal wall
- often performed alongside other prolapse repairs (rarely done alone)
- addresses cystocele and rectocele symptoms
- does not involve mesh
Colpocleisis:
- a closure procedure for patients who do not desire vaginal intercourse
- very durable with the lowest recurrence rates
- shorter surgery and recovery
- LeFort colpocleisis is used when the uterus is still present (to allow for detection of any abnormal bleeding)
- complete colpocleisis is used after hysterectomy
This option is often appropriate for older patients or those prioritizing symptom relief over vaginal function.
How Long Does Prolapse Surgery Last? (Recurrence Risk)
Not all prolapse surgery repairs last forever. The chance of prolapse returning depends on several factors, including age, tissue quality, activity level, and the type of surgery chosen.
In general:
- many repairs last years to decades
- some degree of recurrence is common over time
- a smaller percentage of patients require repeat surgery
Recurrence risk depends on:
- age
- tissue quality
- activity level
- type of surgery chosen
- whether mesh was used
- prior prolapse surgeries
Approximate current recurrence rates by procedure:
- Sacrocolpopexy: about 5–10% recurrence over the medium to long term
- Native-tissue repairs (such as sacrospinous or uterosacral suspensions): estimates around 20–30%, depending on follow-up and technique
- Colpocleisis (obliterative repair): recurrence rates are very low (often <5%), because the vagina is permanently closed — which is the trade-off for sexual function
These numbers are only approximations because studies define recurrence differently and follow-up lengths vary. Most of the time, symptom recurrence is much less common than what might be seen on exam, and many people with mild recurrence do not need another surgery.
Recurrence does not mean failure. Symptoms — not anatomy alone — guide treatment decisions.
Urinary Incontinence and Prolapse Surgery
Urinary symptoms often overlap with prolapse.
Some patients have urinary incontinence before surgery. Others only notice leakage after prolapse is repaired, because the prolapsed tissue was previously masking it.
For this reason, surgeons often perform special testing before prolapse surgery to assess for stress urinary incontinence. If incontinence is identified, it can be addressed at the same time as prolapse surgery.
Options may include placement of a sling or other treatments such as urethral bulking. A good surgeon will evaluate this carefully and review options ahead of time to avoid fixing one problem while creating another.
Risks and Complications
All surgeries carry risk. Common concerns include:
- bleeding or infection
- bladder or bowel injury (uncommon)
- urinary retention or changes in incontinence
- pain with intercourse
- mesh-specific risks (erosion, exposure, discomfort)
Most complications are uncommon, but discussing them ahead of time helps patients make informed choices without fear.
How Does Prolapse Surgery Affect Sex?
Many people report:
- less pressure or bulging
- improved comfort
- improved sexual confidence
Some may experience:
- vaginal tightness
- pain with penetration
- changes in sensation
Risks vary by procedure and can often be minimized with careful surgical planning and pelvic floor therapy.
The Bottom Line
Prolapse surgery isn’t about one right operation — it’s about choosing the right operation for the right person.
Some people never need surgery. Others benefit enormously from it. The best outcomes come from understanding the options, clarifying personal goals, and working with a surgeon who takes the time to individualize care.
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