In the United States, one in three women experience pelvic floor disorders.
It’s a common ailment and so are surgical procedures to treat it.
According to a recent study in the Journal of the American Medical Association (JAMA), failure rates for two procedures used to treat the disorder were equally high, coming in at more than 60 percent.
Despite this high failure rate, more than half of the women surveyed still reported a better quality of life after the procedure.
Pelvic floor disorders can cause incontinence and painful intercourse. They can also cause pelvic organs to bulge into the vaginal canal.
The procedure can improve quality of life but is often a temporary fix.
As part of the study, researchers surveyed nearly 300 women to learn more about their quality of life five years after surgery. Their median age was 57 years old.
The research team examined sacrospinous ligament fixation (SSLF) and ligament vaginal vault suspension (ULS) — two procedures commonly used to treat the disorders.
These surgeries do not involve using synthetic mesh, which has been linked to complications and have produced extensive lawsuits.
Of women who had SSLF, 70 percent reported a failure at 5 years, while 61 percent of women who had ULS reported failure at the same time.
After 5 years, about 12 percent of ULS patients and 8 percent of SSLF patients were treated again.
“This was surprising to us,” said Dr. J. Eric Jelovsek, a lead study author and a researcher from Duke University. “That failure rate was higher than we expected. But that does not necessarily align with how patients feel and we don’t know why that is.”
The trial also looked at the impacts of pelvic muscle floor training and behavioral therapy to see if they could improve outcomes. Neither helped.
Jelovsek said one explanation is that the researchers defined “failure” too stringently. He called for more research to find out the best way to define failure or success.
The results suggest that neither procedure might work as well in the long term as surgeons once thought, Jelovsek said.
Unlike Jelovsek, Dr. Charles Ascher-Walsh, director of gynecology and urogynecology in the Division of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai in New York, said he wasn’t surprised by the results.
“Both of the procedures in this study are vaginal procedures which have been shown to be inferior to the abdominal surgeries for prolapse, as far as prolapse of the top of the vagina is concerned,” he told Healthline.
Ascher-Walsh said doctors know that the classical procedure to fix prolapse of the front and back walls of the vagina have high recurrence rates.
Most patients would not be symptomatic with a drop in the prolapse to one-third of the vaginal length, so the percentages described would include many women who were not aware of the “failure.”
Linda Brubaker, a co-author and professor of pelvic medicine and reconstructive surgery at University of California San Diego, said that there are treatments available for prolapse other than those used.
Advancements on the horizon include better efforts to prevent prolapse and understand why it happens, Brubaker noted.
True prolapse repair involves suspending the vaginal apex instead of using mesh, Brubaker told Healthline.
The procedure that involves suturing the apex (or top portion) of your vaginal wall to pelvis ligaments, as was done in the two types of surgeries studied.
Dr. Erin Duecy, an associate professor of obstetrics, gynecology, and urology at the University of Rochester Medical Center in New York, said that suturing the apex to ligaments provides the support in place of weakened pelvic tissues.
It is also known as a native-tissue repair, as the woman’s own tissues and sutures are used for the repair rather than placing a mesh.
“The days of simply removing the uterus and hoping for the best should be behind us now,” Brubaker added.
Pelvic floor physical therapy is another treatment.
Rachel Gelman, DPT, a therapist at Pelvic Health and Rehabilitation Center in San Francisco, said that therapy has been shown to help reduce symptoms relating to pelvic organ prolapse.
“It is less invasive and more cost effective than surgery,” she told Healthline.
Gelman said the physical therapy can also help patients who need surgery by preparing them for the process and helping them to recover.
Women should not discredit the help that prolapse surgery can provide, Duecy told Healthline.
They should be counseled that prolapse can recur, either in the same area of the vagina where the repair was performed or in a different area.
“We should not consider surgery a definitive cure for prolapse, but a way of managing it and improving [a] women’s quality of life,” Duecy added.