Pelvic Floor Surgery: What You Need to Know

If you worry about a little leak when you laugh too hard or often have a vague feeling of pelvic pressure, you may be dealing with a pelvic floor disorder.

These conditions, which include urinary incontinence and pelvic organ prolapse, are more common than you may realize: They affect about one in four women in the United States.

In the past, many women put off treatment, whether it was because they were embarrassed or they were afraid of treatment. 

But “now that there’s greater publicity regarding intimate conditions like overactive bladder and pelvic organ prolapse, more women are actively seeking out care,” says Stephanie Sansone, M.D., an obstetrician-gynecologist specializing in urogynecology and reconstructive pelvic surgery at Hackensack Meridian Health.

Learn what you need to know about pelvic floor surgery so you can stop putting off that appointment — and start feeling better.

Who performs pelvic floor surgery?

A specialist called a urogynecologist performs pelvic floor surgery. They have specialized training in diagnosing and treating pelvic floor disorders, which affect the muscles and ligaments that support the bladder, uterus and vagina. 

What causes pelvic floor disorders?

Giving birth vaginally significantly increases your risk of pelvic floor disorders, according to one study. Other contributing factors include pregnancy, obesity, menopause and aging. Common pelvic floor disorders include:

• Stress Urinary incontinence: Accidental leakage of urine when you laugh, cough, sneeze or exercise
• Pelvic organ prolapse: When the uterus or bladder drops into the vaginal canal
• Overactive bladder: A sudden, urgent need to go

Why is it important not to put off care for pelvic floor disorders?

Pelvic floor disorders usually don’t go away on their own and may get worse over time, affecting your daily activities and quality of life. The good news: Surgery isn’t always necessary. Many cases can be successfully managed with non-surgical treatments. For example, one large review of research concluded that regular pelvic floor muscle training (gentle exercises to strengthen these muscles) can improve urinary incontinence symptoms. 

Which pelvic floor surgery is most effective?

“One of the biggest myths is that there’s only one surgical approach to fix many of the urogynecology conditions when, in actuality, there are many different approaches that are minimally invasive,” says Alicia Palmieri, D.O., a physician specializing in urogynecology and pelvic reconstructive surgery at Hackensack Meridian Health. “We offer approaches that allow our patients to have more autonomy in the path of their care and choosing how to treat their conditions.”

What does minimally invasive surgery mean?

Minimally invasive surgery typically involves smaller incisions, same-day procedures and faster recovery times. The type you get is based on your age, activity level and other factors. “The beauty of this is that we go through this journey together and choose a route, since we offer all of them,” says Dr. Sansone.

Which pelvic floor disorders can minimally invasive urogynecology procedures treat?

Stress Urinary Incontinence

A strip of synthetic mesh is placed under the urethra through tiny incisions in the vaginal wall to help prevent leakage. A new, non-surgical approach involves injecting a synthetic material into the urethra to help it close better and prevent leaks.

Pelvic Organ Prolapse

Doctors can now perform a robotic-assisted repair, utilizing synthetic materials or incorporating the patient’s own tissue.

Overactive Bladder

A small implantable device that emits gentle electrical pulses can help restore communication between the bladder and brain and reduce urgency symptoms. Doctors at Hackensack Meridian Health are using a new FDA-approved implant called the Altaviva, placed under the skin near the ankle. The outpatient procedure takes around 10 minutes and is quicker and simpler than alternative treatments.

How long does recovery from a urogynecology procedure take?

“Most patients can return to everyday activities within one to two weeks after surgery,” says Dr. Palmieri. Cramping, the most common side effect, may be managed with heat packs, while pain relievers such as ibuprofen (Advil) or acetaminophen (Tylenol) can alleviate both cramping and incision soreness. Full recovery, which may involve restrictions like avoiding weightlifting, takes four to six weeks.

How effective are minimally invasive urogynecology procedures?

“The majority of patients tend to have a positive recovery with relief of symptoms,” says Dr. Sansone. “And if they’re not feeling 100%, we have additional options to help them.” 

The benefits extend beyond physical relief: “Prior to surgery, many patients are nervous about doing certain activities due to fear of leakage,” says Dr. Palmieri. “Surgery allows them to live their lives more fully and enjoyably.

Next Steps & Resources:

• Meet our sources: Stephanie Sansone, M.D., and Alicia Palmieri, D.O.
• Make an appointment online with a urogynecologist near you, or call 800-822-8905. 
• Learn more about our urogynecology services.