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

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.

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

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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.