Pelvic Organ Prolapse Surgery

Pelvic organ prolapse is common. 40% of Canadian women will experience pelvic organ prolapse, and ~15% will undergo surgery.

surgery is an operation to lift and support organs that have dropped into the vagina because the pelvic floor—your body’s natural support system—has been stretched or weakened. These organs can include the bladder (cystocele), uterus or cervix (uterine prolapse), top of the vagina after a hysterectomy (vaginal vault prolapse), and the rectum bulging forward (rectocele).

The goal is to restore normal support so the bulge goes away and everyday activities feel more comfortable.

Surgeons can do this through the vagina, through small cuts on the belly using a camera (laparoscopy or robot‑assisted laparoscopy), or through an open incision if needed. They use stitches with the body’s own tissues (native tissue repair) or, in select cases, a surgical mesh to reinforce support. Examples include anterior or posterior vaginal wall repair, sacrospinous fixation, uterosacral suspension, or sacrocolpopexy to anchor the top of the vagina. Which approach is chosen depends on which organs are bulging, your anatomy, and your goals (for example, whether you want to keep or remove the uterus).

Shorter wait times

• Public queues for pelvic organ prolapse are some of the longest in the country (double that of orthopedic surgeries.
• Private centres often line up consults, imaging, and OR time within weeks—cutting months of living with a bulge, pressure, leakage, and activity limits, and helping you get back to work, caregiving, and exercise sooner.

Choice and control

• Pick a surgeon with the exact expertise you want (native‑tissue repairs, sacrocolpopexy, uterine‑sparing options, re‑do surgery).
• Choose the clinic location (out‑of‑province) and schedule around family, school, or job demands.
• Discuss and select the approach that fits your goals (keep uterus vs hysterectomy, mesh vs native tissue, vaginal vs laparoscopic/robot‑assisted).

Peace of mind

• Clear timelines and a detailed plan—who’s operating, technique, anaesthesia, hospital vs accredited non‑hospital facility, and follow‑ups—reduce uncertainty.
• Direct communication and rapid result sharing make it easier to plan help at home and pelvic floor physiotherapy.

Preventing further decline

• Ongoing prolapse can worsen pelvic pressure, bladder/bowel issues, and skin irritation; some women reduce activity or avoid intimacy.
• Earlier repair may limit compensations (straining, manual splinting) that irritate the pelvic floor and aggravate leakage or constipation.
• Timely care can avoid prolonged use of medications or repeated urgent visits for retention/UTIs in advanced cases.

Personalized technique and supports

• Access to surgeons who routinely perform your preferred repair (e.g., sacrocolpopexy for vault prolapse, uterosacral suspension, sacrospinous fixation) and offer pessary alternatives when appropriate.
• Integrated care: pelvic floor physio, continence options (bulking/slings if needed), and clear post‑op check‑ins.

1. ‍Confirm your diagnosis. Most patients start with a family doctor or specialist who confirms that cystoscopy and/or surgery is advisable, but your urogynecologist can also confirm if needed.
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2. Research. Explore urogynecologist who specialize pelvic organ prolapse surgery.
   
   • You can find urogynecologists in Vancouver, British Columbia; Calgary, Alberta; Toronto, Ontario; and Montréal, Québec on our app, and review qualifications, as well as pricing.
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3. ‍Schedule an initial consultation. Most urogynecologists offer in-clinic and online consults.
   
   • Consultations are usually booked within days or a few weeks.
   • Note: expect a consultation fee between $150 - $350.
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4. ‍Consultation. The urogynecologist will review your condition, symptoms, and any previous treatments or diagnostics, such as x-rays or MRIs.
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5. ‍Post consultation. The surgeon will then review your case and provide surgical options based on your needs; review the risks and expected outcomes; and present pricing and scheduling options.
   
   • Because the procedure is not covered by your provincial health plan when done privately, you’ll need to review the quoted cost and consider payment options (out-of-pocket, private insurance, or financing).
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6. ‍Schedule your surgery date. Once you confirm the procedure and payment, the clinic will schedule your surgery—generally within a few weeks.
   
   • Plan for travel and accommodation, since the surgery will likely take place outside your home province.
   • Expect pre-surgery preparation, and possibly some pre-surgery tests.

Vaginal native‑tissue repairs (e.g., anterior/posterior repair, uterosacral or sacrospinous suspension): about 60–150 minutes. Laparoscopic/robot‑assisted sacrocolpopexy or uterine‑sparing hysteropexy: about 120–240 minutes. Expect extra hours at the centre for check‑in, anaesthesia, and recovery. Some cases go home the same day; others stay overnight.

Basic steps (what actually happens)

Check‑in and plan

• You meet the team, review the plan (which organs are bulging, which repair is chosen), sign consent, and ask last questions.

Anaesthesia

• Most prolapse surgeries use general anaesthesia (asleep). Some vaginal repairs can be done with spinal/epidural.

Position and prep

• You’re positioned on a padded table. The vagina/abdomen is cleaned and covered with sterile drapes. A catheter is placed to keep the bladder empty.

Access

• Vaginal approach: the surgeon works through incisions inside the vagina.
• Laparoscopic/robotic approach: 3–5 tiny belly incisions for a camera and slim instruments.

Fix the problem (examples)

• Anterior/posterior repair: tighten and reinforce the tissues supporting the bladder (front wall) and/or rectum (back wall).
• Apical support: re‑suspend the top of the vagina or uterus using strong stitches (uterosacral or sacrospinous suspension) or attach it to the spine’s ligament with a mesh bridge (sacrocolpopexy/hysteropexy).
• Add‑ons if planned: repair small tears, remove/keep the uterus, or place a continence sling.

Rinse and check

• The surgeon checks support, stops any bleeding, and confirms the bladder/ureters behave normally (often with a quick cystoscopy).

Close up

• Vaginal incisions are closed with dissolving stitches. Laparoscopic incisions are closed with small sutures/skin glue. Dressings are placed.

Wake‑up and instructions

• You recover in PACU, get urine catheter and activity instructions, pain/constipation plans, and go home the same day or after an overnight stay, depending on the case.

Everyone heals differently—follow your surgeon’s plan. Taking it slow and steady usually means better results. Some clinics offer virtual follow‑ups and can coordinate pelvic floor physio near home.

In general, what to expect

Week 1

• Reality check: pelvic pressure, vaginal soreness, bloating/gas, and fatigue. Sitting long is uncomfortable.
• Goals: control pain and swelling, protect the repair, get moving safely.
• Activities: short walks around the house every few hours, keep the incision(s) clean and dry, use stool softener/fibre, drink water, avoid straining and heavy lifting. A catheter may stay for a short time if needed.

Weeks 2–4

• Still annoying but improving.
• Goals: move comfortably and keep bowel/bladder habits regular.
• Activities: daily walks, light chores, no lifting over ~5–10 lb (about a grocery bag), no baths/hot tubs or tampons, nothing in the vagina (no intercourse) until cleared. Stitches inside are dissolvable—mild discharge is normal.

Weeks 5–8

• The rhythm phase.
• Goals: steady energy, minimal pressure, and confidence with daily tasks.
• Activities: longer walks, gentle stationary bike, easy mobility/abdominal breathing work. Still avoid heavy lifting, core‑straining moves, and high‑impact exercise. Discuss starting pelvic floor physio when your surgeon says it’s okay.

Weeks 9–12

• The work phase.
• Goals: rebuild strength and endurance without triggering pressure or bulge sensations.
• Activities: progress low‑impact cardio, add light resistance (arms/legs), gradual core and pelvic floor training with a physio. Many return to desk/school fully; manual work needs clearance.

Months 3–6

• Getting back to “normal‑ish.”
• Goals: full daily function and confident activity.
• Activities: gradual return to heavier lifting and higher‑impact exercise only if cleared. Sexual activity is usually reintroduced after your surgeon gives the go‑ahead.=

Red flags—call your care team

• Fever, worsening pain, spreading redness, or foul‑smelling discharge
• Heavy vaginal bleeding (soaking pads), sudden severe pelvic pain, or a new bulge
• Trouble peeing, burning that worsens, or can’t pass urine
• Calf pain/swelling, chest pain, or shortness of breath

In Canada, private clinics charge between $10,000 to $32,000+.

There is a huge range for pelvic organ prolapse surgery based on type (vaginal native‑tissue repair vs laparoscopic/robotic sacrocolpopexy or hysteropexy), whether a hysterectomy or sling is added, one vs multiple compartments,  province, and OR time. Always ask for a written, itemized quote.

What’s usually included

• Surgeon fee (urogynecology/urology) and anaesthesia services
• Accredited facility/OR fees, nursing, standard disposables, routine instruments
• For laparoscopic/robotic cases: basic use of the platform and standard consumables (if the clinic bundles them)
• Immediate recovery care and 1–2 routine follow‑up visits

What’s often not included

• Initial consults, pre‑op imaging/labs, urodynamics, and cystoscopy if done outside the centre
• Additional procedures (e.g., hysterectomy, continence sling), mesh or graft materials beyond “standard,” and cystoscopy add‑ons if billed separately
• Extra OR time beyond the booked block or an unplanned overnight stay/inpatient admission
• Prescriptions after discharge (pain meds, stool softeners, antibiotics if needed)
• Pelvic floor physiotherapy after surgery
• Travel and accommodation if you’re out‑of‑province/state

Tips to compare quotes

• Ask if the price is a “global bundle” (surgeon + facility + anaesthesia) and request line items.
• Confirm whether mesh/graft materials, cystoscopy, and robotic fees (if used) are included.
• Ask for separate pricing for any planned add‑ons (hysterectomy, sling) and for bilateral/multi‑compartment repair.
• Clarify what happens if more time is needed or if you require an overnight stay.

Choosing your surgeon/clinic is one of the main benefits of pursuing private surgery—here's how to choose wisely.

What to look for

Experience and volume

• Ask how many POP surgeries they do per year and their case mix (anterior/posterior repairs, apical suspensions like uterosacral or sacrospinous, sacrocolpopexy/hysteropexy, re‑do cases, uterine‑sparing).
• Higher volume with routine pathways usually means smoother care and fewer complications.

Credentials and training

• Verify licensure with your provincial college (CPSO Ontario, CPSBC BC, CPSA Alberta, CMQ Québec, etc.).
• Look for FRCSC‑certified urologists or obstetrician‑gynaecologists with fellowship in Female Pelvic Medicine & Reconstructive Surgery (urogynecology) or equivalent focused training.

Technique and tools

• Do they offer both native‑tissue repairs and mesh‑based options (when appropriate), and explain when each makes sense?
• For laparoscopic/robotic cases, confirm consistent access to the platform and proper assistance.

Outcomes and safety

• Request recent data: infection, unplanned return to OR within 30–90 days, urinary retention/UTI rates, mesh complications (if used), prolapse recurrence/persistence, and patient‑reported outcomes (bulge/pressure relief, quality of life).
• Ask about re‑do rates and how they manage complications.

Indications and alternatives

• Make sure non‑operative options were discussed (pessary fit/changes, pelvic floor physio, bowel/bladder strategies). Clear indications = better chance of meeting expectations.

Imaging and planning

• How do exam findings (POP‑Q), bladder testing (urodynamics if needed), and cystoscopy influence the plan?
• If stress leakage is likely, will they consider a sling at the same time?

Facility accreditation

• Confirm the site is accredited (Accreditation Canada/CAAASF or provincial NHMSFAP), with sterilisation standards, anaesthesia coverage, and a hospital transfer agreement.

Rehab integration

• Written after‑care and phased activity plan; coordination with a pelvic floor physiotherapist (virtual options if you’re travelling).

Pricing transparency

• Itemised quote for surgeon, facility, anaesthesia, mesh/graft (if used), cystoscopy, and follow‑ups. Clarify charges for added procedures (hysterectomy, sling) and extra OR time.

Questions to ask during your POP surgery consultation

Surgeon and surgery plan

• How many POP surgeries do you perform yearly, and what’s your experience with my specific pattern (anterior/posterior/apical, post‑hysterectomy vault)?
• What are your last 12–24 month rates for infection, urinary retention, mesh complications (if used), and recurrence?
• Which procedure do you recommend for me (native‑tissue repair, sacrospinous/uterosacral suspension, sacrocolpopexy/hysteropexy) and why? What are the trade‑offs?
• If I have stress leakage or it shows on testing, will you add a sling? How does that change recovery and risks?

Anaesthesia and logistics

• What anaesthesia do you recommend (general vs spinal/epidural)? Same‑day discharge or likely overnight?
• Will you perform a cystoscopy during surgery, and is it included in the plan?

Recovery and after‑care

• When can I return to desk work, light chores, heavier lifting, higher‑impact exercise, and sexual activity?
• What activity limits do you use early on (lifting limit, “nothing in the vagina,” bowel routine)?
• Do you provide a written after‑care plan and referral to pelvic floor physio? When should I start?
• What red flags should trigger a call/ER visit? Who is my direct contact and typical response time? How many follow‑ups are included?

Costs and documentation

• What exactly is included in my quote (surgeon, facility, anaesthesia, mesh/graft if used, cystoscopy, catheter supplies, first follow‑ups)?
• What could add cost (added sling, hysterectomy, longer OR time, admission)? How do you handle consent and pricing if plans change mid‑procedure?
• Will I receive the operative note and a summary for my family doctor/physio?

Signals of a high‑quality program

• Shares outcomes and complication rates openly.
• Offers both native‑tissue and mesh‑based options, with clear indications.
• Provides written after‑care, pelvic floor physio integration, and accessible post‑op support.
• Uses accredited facilities with standardised safety checklists and transparent, itemised pricing.