Do I Need Surgery for Pelvic Organ Prolapse?

Being diagnosed with pelvic organ prolapse does not automatically mean that you need surgery.

Some women have mild prolapse with few or no symptoms and may only need monitoring. Others experience significant pressure, a vaginal bulge, bladder problems, bowel difficulties, or discomfort that interferes with daily life.

The right treatment depends on more than the prolapse stage. Your symptoms, medical history, lifestyle, sexual health, future pregnancy plans, and personal treatment goals all matter.

At Dr. Mariana Bubucea Women’s Wellness & Urogynecology Center, every patient receives a comprehensive Pelvic Floor Evaluation before treatment recommendations are made.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the muscles and connective tissues supporting the pelvic organs become weakened or stretched.

This may allow one or more organs to descend toward or into the vaginal canal, including:

  • The bladder

  • The uterus or cervix

  • The rectum

  • The vaginal apex after hysterectomy

  • The small intestine

Prolapse may develop after pregnancy, vaginal childbirth, menopause, pelvic surgery, chronic constipation, repeated heavy lifting, obesity, or chronic coughing.

When May Prolapse Be Managed Without Surgery?

Surgery may not be necessary when the prolapse is mild, symptoms are manageable, or the patient prefers a conservative approach.

Nonsurgical treatment may include:

Pelvic Floor Physical Therapy

A specially trained pelvic floor therapist can assess muscle strength, coordination, and breathing patterns. Therapy may help improve support and reduce pressure, urinary leakage, or discomfort.

Pelvic floor therapy may improve symptoms, but it does not always reverse advanced prolapse.

Vaginal Pessary

A pessary is a removable device placed inside the vagina to support the pelvic organs.

Pessaries are available in different shapes and sizes and may be used temporarily or long term. A proper fitting and regular follow-up appointments are important for comfort and vaginal health.

Lifestyle Modifications

Reducing repeated pressure on the pelvic floor may help prevent symptoms from worsening.

Recommendations may include:

  • Treating chronic constipation

  • Avoiding unnecessary heavy lifting

  • Managing chronic coughing

  • Maintaining a healthy weight

  • Using proper lifting techniques

  • Avoiding straining during bowel movements

Observation

If prolapse is not causing significant symptoms, periodic monitoring may be appropriate. Treatment can be reconsidered if symptoms change or begin to affect quality of life.

When Should Surgery Be Considered?

Surgery may be considered when prolapse symptoms are moderate to severe, conservative treatment has not provided sufficient relief, or the prolapse is significantly affecting daily activities.

Possible signs that it may be time to discuss surgical treatment include:

  • A vaginal bulge that extends outside the vaginal opening

  • Pelvic pressure that worsens with standing or activity

  • Difficulty emptying the bladder

  • The need to push the prolapse back to urinate or have a bowel movement

  • Recurrent urinary tract infections related to incomplete bladder emptying

  • Bleeding, irritation, or sores on exposed vaginal tissue

  • Difficulty exercising, walking, working, or traveling

  • Discomfort or limitations during intimacy

  • Symptoms that continue despite physical therapy or pessary use

The decision to have surgery should be based on how much the prolapse affects your health and quality of life—not simply on the appearance of the prolapse.

What Types of Prolapse Surgery Are Available?

The appropriate procedure depends on which organs are involved, whether the uterus is present, previous surgeries, the severity of the prolapse, and your goals.

Treatment options may include:

Anterior Vaginal Wall Repair

This procedure supports the front wall of the vagina when the bladder has dropped into the vaginal canal. It is commonly used for bladder prolapse, also called cystocele.

Posterior Vaginal Wall Repair

This procedure strengthens the back wall of the vagina when the rectum is bulging forward, a condition called rectocele.

Vaginal Apex or Uterine Support

Surgery may be performed to restore support to the uterus, cervix, or top of the vagina after a previous hysterectomy.

Uterus-Preserving Prolapse Repair

Some patients may be candidates for prolapse repair without removing the uterus. The benefits and limitations of uterus-preserving surgery should be discussed during the surgical consultation.

Hysterectomy With Pelvic Floor Reconstruction

When uterine prolapse is present, hysterectomy may sometimes be performed together with reconstruction of the supporting tissues.

Removing the uterus alone does not repair every type of prolapse. Proper support of the vaginal apex is an important part of surgical planning.

Robotic Pelvic Floor Surgery

Robotic-assisted minimally invasive surgery may be used for selected prolapse repairs, including procedures that restore support to the vagina or uterus.

The robotic approach allows the surgeon to operate through small incisions with enhanced visualization and precise instrument movement within the pelvis.

The robotic system does not perform the operation independently. Every movement is controlled by the surgeon.

Will Surgery Also Correct Urinary Leakage?

Not always.

Pelvic organ prolapse and urinary incontinence frequently occur together, but they are different conditions. Some women leak urine with coughing, laughing, sneezing, or exercise. Others experience urgency, frequency, or difficulty emptying the bladder.

In some cases, advanced prolapse may temporarily hide stress urinary incontinence. Leakage may become more noticeable after the prolapse is corrected.

For this reason, bladder testing may be recommended before surgery. If urinary incontinence is identified, an additional procedure may sometimes be performed during the same operation.

How Is the Best Treatment Selected?

A Pelvic Floor Evaluation may include:

  • Detailed review of symptoms and treatment goals

  • Pelvic examination

  • POP-Q prolapse measurements

  • Assessment of the bladder, uterus, vaginal walls, and vaginal apex

  • Pelvic floor muscle evaluation

  • Urinalysis or urine culture

  • Measurement of urine remaining after urination

  • Cough stress testing

  • Urodynamic testing when clinically appropriate

  • Pelvic ultrasound or other imaging when needed

This evaluation helps determine which organs are affected, whether bladder or bowel dysfunction is also present, and which treatment options may provide the greatest benefit.

Questions to Ask Before Choosing Surgery

Before deciding on prolapse surgery, ask:

  • Which organs are prolapsing?

  • What stage is my prolapse?

  • Do I have bladder or bowel dysfunction?

  • Are nonsurgical treatments appropriate for me?

  • Can my uterus be preserved?

  • Would hysterectomy be necessary?

  • Which surgical approach is recommended?

  • Will urinary incontinence require separate treatment?

  • What restrictions will I have during recovery?

  • What are the risks of recurrence or future treatment?

A clear discussion of these questions can help you make an informed and confident decision.

Personalized Prolapse Treatment With Dr. Mariana Bubucea

Dr. Mariana Bubucea specializes in pelvic organ prolapse, bladder prolapse, urinary incontinence, pelvic floor reconstruction, and robotic-assisted minimally invasive surgery.

Her approach begins with identifying the exact cause of your symptoms. Treatment is then personalized to your anatomy, health history, lifestyle, and goals.

Not every woman needs surgery. However, when surgery is the most appropriate option, careful planning can help restore pelvic support, improve bladder and bowel function, and help you return to a more active and comfortable life.

Schedule a Pelvic Floor Evaluation

You do not have to wait until prolapse becomes severe or begins controlling your daily activities.

Schedule a consultation if you experience:

  • A vaginal bulge

  • Pelvic pressure or heaviness

  • Bladder leakage

  • Difficulty urinating

  • Incomplete bladder emptying

  • Bowel movement difficulties

  • Discomfort during intimacy

  • Symptoms that worsen with standing or activity

Our clinic serves patients from Hallandale Beach, Aventura, Hollywood, Sunny Isles Beach, North Miami Beach, Fort Lauderdale, Miami, Boca Raton, and throughout South Florida.

Dr. Mariana Bubucea Women’s Wellness & Urogynecology Center

2500 E Hallandale Beach Blvd., Suite 401
Hallandale Beach, FL 33009

Phone: 954-395-2585

Schedule your Pelvic Floor Evaluation today to learn whether conservative management or surgical prolapse repair is the right option for you.