Urinary Incontinence and Pelvic Organ Prolapse Surgery
Two common problems that can affect daily life
Do you leak urine when you cough, laugh, exercise or climb stairs? Do you feel pressure, heaviness or a bulge in the vaginal area? Do you often rush to the toilet or feel that your bladder does not empty completely?
These symptoms may be related to urinary incontinence, pelvic organ prolapse, or both. Although these conditions are common, they should not be accepted as an unavoidable part of aging or childbirth. With proper evaluation and individualized treatment, quality of life can often be significantly improved.
What is pelvic organ prolapse?
Pelvic organ prolapse occurs when the muscles, ligaments and connective tissues supporting the pelvic organs become weakened. As a result, organs such as the bladder, uterus, rectum or the top of the vagina may move downward and create pressure or a bulge in the vaginal canal.
Ask yourself: Do you feel a vaginal bulge or heaviness that becomes more noticeable after standing, walking or lifting?
Different types of prolapse may occur:
Cystocele: The bladder bulges into the front wall of the vagina.
Uterine prolapse: The uterus descends into the vaginal canal.
Rectocele: The rectum bulges into the back wall of the vagina.
Vaginal vault prolapse: The top of the vagina descends, usually after hysterectomy.
Prolapse may be mild and discovered only during examination, or it may cause significant symptoms affecting urination, bowel movements, sexual function and daily activities.
What are the types of urinary incontinence?
Urinary incontinence is not a single condition. Identifying the type of leakage is essential for choosing the right treatment.
Stress urinary incontinence
This is leakage that occurs during coughing, sneezing, laughing, exercising, lifting or sudden movement. It is usually related to weakness in the support of the urethra and bladder neck.
Question: Does leakage mostly happen when you cough, laugh, walk fast or exercise?
Urgency urinary incontinence
This is leakage associated with a sudden, strong urge to urinate. Patients may feel they cannot reach the toilet in time. Frequent urination and waking at night to urinate may also occur.
Question: When you feel the need to urinate, is it difficult to postpone?
Mixed urinary incontinence
This includes features of both stress and urgency incontinence. Treatment depends on which symptom is more bothersome.
What are the symptoms?
Urinary incontinence and pelvic organ prolapse may occur separately or together. Common symptoms include:
Leakage during coughing, laughing, exercise or lifting
Sudden urgency and inability to reach the toilet
Frequent urination
Waking at night to urinate
Vaginal pressure, heaviness or dragging sensation
A visible or palpable vaginal bulge
Difficulty starting urination
Feeling of incomplete bladder emptying
Constipation or difficulty with bowel movements
Need to press on the vagina to empty the bowel
Discomfort during sexual intercourse
Avoidance of sports, travel or social activities due to symptoms
Having these symptoms does not always mean surgery is needed. However, a proper medical evaluation is important.
How is the diagnosis made?
Diagnosis begins with a detailed medical history and pelvic examination. The clinician will ask about the type of symptoms, when they occur, childbirth history, previous surgeries, menopause status, medications, bowel habits and the impact on daily life.
The evaluation may include:
Pelvic examination: To assess the type and degree of prolapse.
Cough stress test: To observe leakage during coughing, often with a comfortably full bladder.
Urinalysis: To rule out infection or blood in the urine.
Bladder diary: To record fluid intake, frequency of urination and leakage episodes.
Post-void residual measurement: To check how much urine remains in the bladder after urination.
Urodynamic testing: Not required for every patient, but useful in complex cases, previous failed surgery, unclear diagnosis or difficulty emptying the bladder.
Important question: How much do these symptoms affect your quality of life? Treatment decisions should be based not only on examination findings, but also on your symptoms, expectations and daily needs.
What are the treatment options?
Treatment should be individualized. Age, general health, symptom severity, type of incontinence, degree of prolapse, sexual activity, future pregnancy plans, previous surgeries and personal preferences all play a role.
Non-surgical treatment options
Surgery is not the first or only option for every patient. Conservative treatments can be effective, especially in mild to moderate symptoms.
Lifestyle modifications
Weight management, treatment of constipation, avoiding heavy lifting, controlling chronic cough, stopping smoking and adjusting fluid or caffeine intake may reduce symptoms.
Pelvic floor muscle training
Properly performed pelvic floor exercises can improve stress urinary incontinence and mild prolapse symptoms. Supervised pelvic floor physiotherapy may increase effectiveness.
Bladder training
Bladder training is especially useful for urgency symptoms. It aims to improve bladder control and gradually increase the time between voids.
Medication
Certain medications may be used for urgency urinary incontinence to reduce involuntary bladder contractions. The choice of medication depends on age, medical history, other medications and possible side effects.
Vaginal pessary
A pessary is a supportive device placed inside the vagina. It can help support prolapsed organs and may be suitable for patients who want to avoid surgery, are not good surgical candidates or need temporary support.
When is surgery considered?
Surgery may be considered when:
Symptoms significantly affect daily life
Conservative treatments are not sufficient
Prolapse is advanced
Urination, bowel function or sexual function is affected
Stress urinary incontinence is persistent and bothersome
The patient prefers a more definitive anatomical correction
The decision for surgery should be made after careful counseling. Benefits, risks, alternatives, recovery expectations and the possibility of recurrence should be clearly discussed.
Surgical options for urinary incontinence
Mid-urethral sling surgery
This is one of the most commonly used surgical options for stress urinary incontinence. A narrow supportive sling is placed under the middle part of the urethra to improve support during coughing, movement or physical activity.
Careful patient selection is important. Before surgery, stress incontinence should be clearly identified, urgency symptoms should be assessed, and the patient should be informed about expected benefits and possible risks.
Autologous fascial sling
This procedure uses the patient’s own tissue to create support under the urethra. It may be preferred in selected cases. The operation and recovery process may differ from synthetic sling procedures.
Burch colposuspension
This procedure supports the bladder neck and urethra. It can be performed through an abdominal, laparoscopic or robotic approach in selected patients.
Urethral bulking injections
A bulking agent is injected around the urethra to reduce leakage. It is less invasive, but the effect may be more limited and repeat treatments may be needed.
Surgical options for pelvic organ prolapse
The goal of prolapse surgery is to restore pelvic organs to a better-supported anatomical and functional position.
Anterior and posterior vaginal repair
These procedures are used for weakness of the front or back vaginal wall. The vaginal tissues are reinforced to better support the bladder or rectum.
Surgery for uterine prolapse
For uterine prolapse, either hysterectomy or uterus-preserving surgery may be considered. The decision depends on age, uterine disease, desire for fertility, sexual function and patient preference.
Vaginal vault prolapse repair
After hysterectomy, the top of the vagina may descend. Surgical repair can be performed through the vaginal route or through abdominal, laparoscopic or robotic approaches.
Sacrocolpopexy or sacrohysteropexy
These procedures can be performed through open, laparoscopic or robotic surgery. The top of the vagina or the uterus is supported by attaching it to strong pelvic ligaments. They may be effective options in selected patients.
Colpocleisis
This is an obliterative procedure in which the vaginal canal is closed to correct prolapse. It may be suitable for selected patients who are older, have significant surgical risk or do not wish to have vaginal intercourse in the future. Careful counseling is essential.
Can prolapse and urinary incontinence be treated in the same operation?
Yes, in some patients, prolapse and stress urinary incontinence can be treated during the same surgery. However, this decision must be individualized. In some cases, prolapse may hide stress leakage; after prolapse repair, urinary leakage may become more noticeable. This is why preoperative evaluation is very important.
Key question: Which symptom bothers you most: urine leakage, vaginal bulge, or both?
Recovery after surgery
Recovery depends on the type of operation, general health and whether additional procedures were performed. Mild pain, vaginal spotting, tiredness and pelvic discomfort can occur during the early recovery period.
Patients are usually advised to:
Avoid heavy lifting
Prevent constipation
Avoid sexual intercourse for the period recommended by the surgeon
Take prescribed medications as directed
Attend follow-up visits
Contact the doctor in case of fever, foul-smelling discharge, severe pain, inability to urinate or heavy bleeding
Why is follow-up important?
Follow-up is an essential part of treatment. Early visits focus on wound healing, infection, pain control and bladder emptying. Later visits assess prolapse symptoms, urinary leakage, sexual function, bowel habits and patient satisfaction.
Some patients may need additional pelvic floor exercises, bladder training, medication or lifestyle adjustments. Rarely, further treatment or repeat surgery may be necessary.
When should you see a doctor?
Medical evaluation is recommended if:
Urinary leakage affects your daily life
You feel a vaginal bulge, pressure or heaviness
You cannot reach the toilet in time
You have difficulty urinating or emptying your bladder
You have recurrent urinary tract infections
Your sexual life is affected by these symptoms
You previously had surgery and symptoms have returned
Conclusion
Urinary incontinence and pelvic organ prolapse are common but treatable conditions. Treatment should be tailored to each patient. Some women benefit from exercises, lifestyle changes, medication or pessary use, while others may require surgery.
With accurate diagnosis, appropriate patient selection, detailed counseling and regular follow-up, safe and effective results can often be achieved.
This article is for general educational purposes only. Please consult your physician for diagnosis and individualized treatment.
