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Pelvic Organ Prolapse FAQ

Sep 28, 2022

What causes Pelvic Organ Prolapse?
Pelvic organ prolapse occurs when muscles and ligaments in the pelvic floor are stretched to become too weak to hold the pelvic organs in the correct position. Potential causes include pregnancy and childbirth, aging and menopause, obesity, pelvic tumors, chronic coughing, chronic constipation, heavy lifting, prior pelvic surgeries or genetic factors.1

What are some symptoms of Pelvic Organ Prolapse?2
Pressure or discomfort in the vaginal or pelvic area, often made worse with physical activities such as prolonged standing, jogging or bicycling. Other symptoms include:
• Diminished control in the bladder and/or bowels
• A bulge near the opening of the vagina
• Painful intercourse


What are the treatment options for Pelvic Organ Prolapse?
Depending on the severity and the type of prolapse, your physician will discuss the different treatment options you may want to consider. Pelvic floor exercises to strengthen the pelvic floor, known as Kegels, may be adequate for mild cases.3 Another treatment option is a pessary, a ring-like device worn in the vagina to provide support for the organs that have fallen (or prolapsed). Pessaries are typically fitted by healthcare professionals. If symptoms are still bothersome and can’t be managed with a pessary or other
non-surgical options, surgery may be needed. All treatment options should be discussed with your physician.4


When is surgery recommended to treat Pelvic Organ Prolapse? What are examples of surgeries that are performed to treat Pelvic Organ Prolapse?
If non-surgical treatments do not provide sufficient relief of your symptoms and your pelvic organ prolapse continues to cause pain, problems with bowel and bladder functions or if it interferes with your sexual activity, you may choose to discuss surgical options with your doctor. The goal of any type of surgical treatment for prolapse is to repair the supporting tissue of the prolapsed organ or vaginal wall using either the patient’s own tissues or a surgical mesh. Surgeries can be performed either through the abdomen
or the vagina. Surgeries performed via the abdomen may be performed laparoscopically or through open abdominal incisions. It’s important to discuss all of your options with your physician to determine which treatment plan is most appropriate for your specific medical situation.
• Surgical procedures that use patients’ own tissues and ligaments to treat pelvic organ prolapse include Modified McCall culdoplasty, high uterosacral ligament suspension, uterosacral ligament fixation and sacrospinous ligament fixation.5
• Surgical procedures that use surgical mesh to treat prolapse via an abdominal incision include
sacrohysteropexy or sacralcolpopexy.6,7

• If a physician determines that the patient’s uterus is prolapsing into the vagina, the surgical removal of
the uterus (hysterectomy) may be recommended as a treatment option for pelvic organ prolapse.8


How is surgical mesh used in the treatment of Pelvic Organ Prolapse?
Surgical mesh is a medical device that is generally used to repair weakened or damaged tissue. In urogynecologic procedures, surgical mesh is permanently implanted to reinforce the weakened vaginal wall to repair pelvic organ prolapse.7


What types of materials may be used and what are the risks?
There are several surgical materials that could be used to facilitate your repair. These include a synthetic
polypropylene mesh or biologic grafts made of human dermis. The material will reinforce the vaginal wall
at the location of the pelvic organ prolapse. Potential Adverse Events associated with implanting synthetic mesh in pelvic organ prolapse procedures can be found below.


Please consult your physician to discuss the associated risk and complications for the specific surgical material you receive. Below is a list of potential adverse events for Boston Scientific’s pelvic organ prolapse
surgical material.


Potential adverse events, any of which may be ongoing, include but are not limited to: Abscess (swollen area within the body tissue, containing a buildup of pus), Adhesion formation (when a scar extends from within one area to another), Allergic reaction (hypersensitivity) to the implant, Bruising, Bleeding, Constipation, Dehiscence (opening of the incision after surgery), De novo detrusor instability (involuntary contraction of the bladder wall leading to an urge to urinate), Dyspareunia (pain during sexual intercourse) that may not resolve, Sexual dysfunction (difficulty with sexual response, desire, orgasm or pain); including the inability to have intercourse, Erosion into organs; exposure/extrusion into vagina (when the mesh goes through the vagina into other organs or surrounding tissue), Exposed mesh may cause pain or discomfort
to the patient’s partner during intercourse, Fistula formation (a hole/ passage that develops through the wall of the organs) which may be acute or chronic, Foreign body reaction (body’s inflammatory response
to the implant) which may be acute or chronic, Granulation tissue formation (reddish connective tissue that forms on the surface when a wound is healing), Hematoma formation (a pool of blood under the
skin/bruising), Hemorrhage (profuse bleeding), Infection, Inflammation (redness, heat, pain or swelling at the surgical site as a result of the surgery) which may be acute or chronic, Injury to ureter (the duct that
urine passes from the kidneys to the bladder), Scarring/scar contracture (tightening of the scar), Mesh contracture (mesh shrinkage), Tissue contracture (tightening of the tissue) Necrosis (death of living tissue in
a small area), Nerve injury (injury to the nerve fiber), Organ perforation (a hole in or damage to these or other tissues that may happen during placement), Pain: pelvic, vaginal, groin/thigh, dyspareunia-which may
become severe, Perforation or laceration of vessels, nerves, bladder, or bowel (a hole in or damage to these or other tissues that may happen during placement), Post-operative bowel obstruction (blockage that
keeps food or liquid from passing through the small or large intestines), Prolapse/recurrent prolapse (complete failure of the procedure), Vaginal shortening or stenosis which may result in Dyspareunia and/
or Sexual Dysfunction, Voiding dysfunction: incontinence, temporary or permanent lower urinary tract obstruction, difficulty urinating, pain with urination, overactive bladder, and retention (involuntary
leakage of urine or reduced or complete inability to empty the bladder). The occurrence of one or more of these complications may require treatment or surgical intervention. In some instances, the complication
may persist as a permanent condition after the surgical intervention or other treatment. Removal of mesh or correction of mesh-related complications may involve multiple surgeries. Complete removal of
mesh may not be possible and additional surgeries may not always fully correct the complications.


How likely is it that my prolapse will recur after surgery?
As with any procedure, some patients will have success while others will not. It is difficult to estimate your specific results. Your physician will explain all of your options and determine with you which treatment plan is most appropriate for your specific medical situation. Your physician will consider a number of factors to determine the likelihood of recurrence in your situation. The most appropriate treatment plan for you will be determined by taking many of these factors into consideration. The ultimate goal is to give you a lasting repair.

What if the surgical mesh comes through my vaginal wall at some point after surgery?
Exposure of the mesh (the presence of mesh material through the surrounding tissue) or mesh erosion (presence of mesh material within the organs surrounding the vagina) can occur following treatment of pelvic organ prolapse with surgical mesh. Treatment of these complications may include additional surgical procedures that may not correct the complication. Your physician will decide the best course of treatment for you if mesh erosion or exposure occur. Surgical mesh exposure and pain can occur years after initial mesh placement. Therefore, it is important to continue with your annual and other routine checkups and
follow-up care.8


If a surgical mesh is to be used in my surgical Pelvic Organ Prolapse repair, will my physician have
information on the product to be implanted?
Yes. You should ask your physician to give you a copy of any patient education information that he or she may have for the specific product used during your surgery, and keep it in your personal surgical file.


What should I expect after surgery?
Before your discharge from the hospital, you may be given a prescription for medication to relieve any discomfort you may experience. You will be instructed on how to care for your incision area. At the discretion of your physician, most patients resume moderate activities within 6 to 8 weeks, with no strenuous activity for up to 12 weeks to allow for healing.


What can I expect during recovery?
Every patient’s recovery experience is unique, and you should consult with your physician as to what he or she expects in your case. Your doctor will determine which kind of anesthesia will be used during your surgery, the length of time you may be hospitalized after the surgery, your need for additional medication following the surgery (for example antibiotics) and whether you will have to go home with a catheter (a flexible plastic tube that drains urine from your bladder). After undergoing prolapse surgery, you may
feel sore. Notify your physician immediately if you have pain with urination, bleeding, painful sexual intercourse, severe pain, defecatory problems or other problems after surgery.
Please consult with your physician on activities to avoid during recovery.9


Learn more at chooseyou.com.


Content is provided by Boston Scientific. Boston Scientific is dedicated to transforming lives through innovative medical solutions that improve the health of patients around the world. 



REFERENCES
1. https://www.voicesforpfd.org/pelvic-organ-prolapse/ Accessed June 2021
2. https://www.voicesforpfd.org/pelvic-organ-prolapse/symptoms-types/ Accessed June 2021
3. https://www.voicesforpfd.org/about/physical-therapy/ Accessed on June 2021
4. https://www.voicesforpfd.org/about/pessaries/ Accessed on June 2021
5. Irvin W, Hullfish, K. Surgical management of vaginal vault prolapse. OBG Management. 2005 Nov;17(11):22-8.
6. https://www.webmd.com/women/guide/medical-treatments-pelvic-organ-prolapse Accessed June 2021
7. https://www.voicesforpfd.org/pelvic-organ-prolapse/surgery/ Accessed June 2021
8. Cheng YW, Su TH, Wang H, et al. Risk factors and management of vaginal mesh erosion after pelvic organ prolapse surgery. Taiwan J Obstet Gynecol. 2017 Apr;56(2):184-7.
9. Recommendations for Patients Considering Treatment for Pelvic Organ Prolapse with Surgical Mesh.
https://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/ UCM262756.pdf. Accessed September 28, 2018.

Treatment Options for POP

15 Sep, 2022
You don’t have to live with the symptoms of pelvic organ prolapse. Pelvic Organ Prolapse can be treated in several ways, depending on the exact nature of the prolapse and its severity. The goal of these treatments is to restore prolapsed organs to their normal anatomical positions. You and your physician may discuss: Non-Surgical Options: Changes to your diet and fitness routine.1 Use of a “pessary,” which is a device designed to relieve symptoms when in place by holding up the vaginal walls. It is inserted vaginally and is removable.2 Physical therapy such as Kegel exercises, designed to increase strength and maintain elasticity in the pelvic muscles.1 Surgical Options: Transvaginal graft repair – A biological graft is placed over the weakened connective tissue and sutured to correct the prolapsed area.3 Sacrocolpopexy / sacrohysteropexy – The physician uses an open, laparoscopic or robotic approach and attaches a graft between the vaginal apex and the tailbone. Depending on the technique used, a hysterectomy (removal of the uterus) may be required.4 Native tissue repair – The physician uses sutures to sew the weakened vaginal wall tissue back together.5 Many surgical procedures have been developed for the correction of pelvic organ prolapse. Please consult your physician to discuss the treatment options, including the potential adverse reactions/complications and post-operative care. What should I expect after surgery? Before your discharge from the hospital, you may be given a prescription for medication to relieve any discomfort you may experience. You will be instructed on how to care for your incision area. At the discretion of your physician, most patients resume moderate activities within 6 to 8 weeks, with no strenuous activity for up to 12 weeks to allow for healing.  For more specific information on what to expect following any of the prolapse surgical options please consult with your physician. Learn more here. CONTENT IS PROVIDED BY BOSTON SCIENTIFIC. BOSTON SCIENTIFIC IS DEDICATED TO TRANSFORMING LIVES THROUGH INNOVATIVE MEDICAL SOLUTIONS THAT IMPROVE THE HEALTH OF PATIENTS AROUND THE WORLD. REFERENCES: 1. Physical Therapy. Voices for PFD. www.voicesforpfd.org/about/physical-therapy. Accessed June 2021. 2. Pessaries. Voices for PFD. www.voicesforpfd.org/about/pessaries. Accessed June 2021. 3. Pelvic Organ Prolapse Treatments: Mesh Information. Voices for PFD. www.voicesforpfd.org/pelvic-organ- prolapse/mesh-information. Accessed June 2021. 4. Pelvic Organ Prolapse Treatments: Surgery. Voices for PFD. www.voicesforpfd.org/pelvic-organ-prolapse/ surgery. Accessed June 2021. 5. Surgery for Pelvic Organ Prolapse. ACOG. www.acog.org/womens-health/faqs/surgery-for-pelvic-organ- prolapse. Accessed June 2021.

What is Pelvic Organ Prolapse?

10 Sep, 2022
When a pelvic organ becomes displaced or slips down in the pelvis, it is referred to as a prolapse. You may have heard women refer to their “dropped bladder” or “fallen uterus.” This problem afflicts over 3 million women in the United States. 1 What causes pelvic organ prolapse? Pelvic organ prolapse occurs when muscles and ligaments in the pelvic floor are stretched or become too weak to hold the organs in the correct position in the pelvis. Potential risks include pregnancy and childbirth, aging and menopause, obesity, pelvic tumors, chronic coughing, chronic constipation, heavy lifting, prior pelvic surgeries, some neurological conditions and certain genetic factors. 2 What are some of the symptoms? Symptoms of pelvic organ prolapse can include: Pressure or discomfort in the vaginal or pelvic area, often made worse with physical activities such as prolonged standing, jogging or bicycling. Diminished control in the bladder and/or the bowels. Painful intercourse. 3 What type of Pelvic Organ Prolapse do I have? 3
Urinary Incontinence FAQs

Urinary Incontinence FAQs

26 Aug, 2022
You’ve got questions, and we’ve got answers.
Stress Urinary Incontinence Treatment Options

Stress Urinary Incontinence Treatment Options

12 Aug, 2022
Many times, conservative treatment options for stress urinary incontinence are used initially. Some of those treatment options include behavioral modification — such as decreasing fluid intake, timed voiding and eliminating caffeine, or pelvic floor muscle training such as Kegel exercises to strengthen the pelvic floor and sphincter muscles. These types of treatments may or may not improve symptoms. When symptoms are more severe, or conservative options aren’t working, bulking agent injections or surgery may be an option. Stress urinary incontinence can be treated in several ways, depending on the exact nature of the incontinence and its severity. As disease state and anatomy differ for each patient, outcomes may vary. Consult a specialist for all available treatment options. Non-Surgical Options: Changes to your diet and fitness routine2 Use of a “pessary,” which is a device designed to relieve symptoms when in place by holding up the vaginal walls. It is inserted vaginally and is removable.³ Physical therapy such as Kegel exercises, designed to increase strength and maintain elasticity in the pelvic muscles. Surgical Options: Traditional Mesh Slings – Refers to a full-length sling that utilizes the ingrowth of surrounding tissue to remain in place and support the urethra to reduce stress urinary incontinence. Single Incision (Mini) Sling Placement – Refers to surgical delivery of a mini mid-urethral sling through a single vaginal incision. Retropubic Colposuspension – Procedure used to treat stress incontinence by suspending a sagging bladder neck and urethra to the pubic bone. Bulking – Procedure in which a bulking agent is injected under the urethra and bladder neck to treat stress urinary incontinence. How will my surgery be performed? Your minimally invasive sling procedure is estimated to only take 30 - 45 minutes. Your doctor will determine the type of anesthesia you will have during the procedure. Once the anesthesia takes effect, your doctor will begin the procedure. A small incision will be made in the vaginal area. Next, the synthetic mesh implant is placed to create a “sling” of support under the urethra. When your doctor is satisfied with the position of the mesh, he or she will close and bandage the small incisions in the groin area (if applicable for your sling type) and the top of the vaginal canal. What should I expect after surgery? Before you are discharged from the hospital, you may be given a prescription for an antibiotic and/or pain medication to relieve any discomfort you may experience. You will be instructed on how to care for your incision area. At the discretion of your physician, there may be some physical restrictions, such as heavy lifting and pelvic rest, and most patients resume moderate activities within 2 to 4 weeks, with no strenuous activity for up to 6 weeks. When will I stop leaking? Most women see results right after the procedure. Talk with your physician about what you should expect. Will a mid-urethral sling cure my incontinence symptoms with 100% certainty? There is no surgery for incontinence that has a 100% cure rate. Please consult your physician about your specific surgery and situation to learn more on what you may expect. Content is provided by Boston Scientific. Boston Scientific is dedicated to transforming lives through innovative medical solutions that improve the health of patients around the world. Download patient brochure to learn more. REFERENCES 1. Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. Women: 2010 to 2050. Obstet Gynecol. 2009 Dec;114(6):1278-1283. doi: 10.1097/AOG.0b013e3181c2ce96 PMID: 19935030. 2. https://www.voicesforpfd.org/bladder-control/sui-treatment/ Accessed June 2021 3. https://www.voicesforpfd.org/about/pessaries/ Accessed June 2021 4. Data on File at Boston Scientific.
Stress Urinary Incontinence

What is Stress Urinary Incontinence?

01 Aug, 2022
Stress urinary incontinence (SUI) is defined as the involuntary leakage of urine. The problem afflicts approximately 18 million women in the United States.1 It usually takes four to six years to see a healthcare professional for this condition.4 What are some of the symptoms and how is it caused? Stress urinary incontinence is the involuntary loss of urine during physical activity, which may include but is not limited to: coughing, laughing or lifting. Incontinence occurs when the muscles that support the urethra (the tube that carries urine out of the body) are weakened or damaged. This can happen as a result of childbirth, trauma, hormone changes and many other reasons. You don’t have to live like this. This type of incontinence can be treated both surgically or nonsurgically. FACT: 1 in 2 adult women experience involuntarily urine leakage.1 FACT: It is a treatable condition. FACT: It is NOT a normal part of aging. FACT: Learning more is your first step toward relief. FACT: We are here to provide you with a treatment plan. Bladder leakage isn’t just a part of getting older. It can happen to women of all ages —and it’s treatable! Maybe you, a sister or a close friend has experienced bladder leakage. You exert yourself, lift something heavy, or maybe just laugh or sneeze — and there it is. It might be a drop of urine, a teaspoonful or a brief stream. It’s called stress urinary incontinence, or SUI. The good news: It is NOT a normal part of aging – and it may be treatable. Types of SUI One condition is called hypermobility, “hyper” means too much and “mobility” refers to movement, which can result from childbirth, previous pelvic surgery or hormonal changes. Hypermobility occurs when the normal pelvic floor muscles can no longer provide the necessary support to the urethra. This may lead to the urethra dropping when any downward pressure is applied, resulting in involuntary leakage. Another condition is called intrinsic sphincter deficiency, also sometimes referred to as ISD. This refers to the weakening of the urethral sphincter muscles or closing mechanism. As a result, the sphincter does not function normally regardless of the position of the bladder neck or urethra.
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