Can prolapse come back after surgery?
Yes. Prolapse can come back after surgery, and how often depends on how you count it. Many women who show some change on exam years later have no symptoms and need nothing more. A smaller group has a bulge or pressure that bothers them again, and they still have good options.
What the numbers mean
What your surgeon measures on exam and what you feel day to day are different things.
- Change on exam: in large trials that followed women for 5 to 7 years, about a quarter to half had some prolapse return on exam, depending on the procedure and how strictly it was measured
- Needing more treatment: about 5% to 12% over the same period
The definition matters a lot. When researchers applied 18 different definitions of success to the same group of women after sacrocolpopexy, success ranged from 19% to 97%. The measure that best matched whether women felt their surgery worked was simple: no longer feeling a bulge.
In the multicenter Pelvic Floor Disorders Registry, about 2 in 100 women or fewer needed retreatment at 1, 2, or 3 years after surgery, and 93% to 98% said they were much or very much better.
Recurrence is not a one-way street either. In the OPTIMAL trial, more than a third of women who met the definition of failure at one visit met the definition of success at a later visit, with no added treatment. One exam finding does not mean things will keep getting worse.
Does the type of surgery matter?
Less than many people expect. In the registry, recurrence at 12 months was about 14% after both vaginal repair with your own tissue and sacrocolpopexy. Colpocleisis, which closes the vaginal canal, had a lower rate (8%), but the gap between groups was small enough to be chance.
How far the prolapse drops before surgery matters more. When the front vaginal wall sits more than 6 cm past the opening, a vaginal repair with your own tissue holds less than half the time. For those women I may suggest sacrocolpopexy instead.
Risk factors for recurrence
- Higher body weight: in one trial, each 5-point rise in BMI raised the risk of failure about 1.7 times
- Smoking, which nearly tripled the odds of failure in another trial
- More advanced prolapse before surgery
- Living with prolapse symptoms longer before surgery
- Prior hysterectomy, linked to about 1.8 times the risk in registry data
- Chronic straining from constipation, or a chronic cough
We go over which of these apply to you before surgery.
Reducing your risk
- Reach and keep a healthy weight
- Stop smoking, ideally well before surgery
- Treat constipation so you are not straining on the toilet
- Get a chronic cough treated
Pelvic floor physical therapy helps with many pelvic floor problems, but it has not been shown to make a prolapse repair last longer. In the OPTIMAL trial, women who did a structured pelvic floor program before and after surgery had the same prolapse outcomes at 2 and 5 years as women who did not.
Lifting limits after surgery are also looser than they used to be. Coughing, having a bowel movement, and getting up from a chair raise pressure in the belly as much as lifting does. In recent studies, women given unrestricted activity after minimally invasive prolapse surgery did no worse. Follow the activity plan we set before your surgery.
If prolapse does come back
A return of prolapse does not automatically mean another surgery. We choose based on what bothers you:
- Watching it, if symptoms are mild or absent
- A pessary, a removable device that holds the vaginal walls up
- Pelvic floor physical therapy with one of the therapists in our office, for symptoms like pressure or trouble emptying
- Repeat surgery, if symptoms get in the way of your daily life. In one series, sacrocolpopexy after a failed earlier repair succeeded about as often as it did as a first surgery (73% vs 82%), though complications were more common.
When to get checked
Make an appointment if you feel a bulge again, notice new pressure, or have trouble emptying your bladder or bowels after surgery. If a change shows up on exam and you have no symptoms, it usually needs only watching.
References
- Barber MD, Brubaker L, Nygaard I, et al. Defining success after surgery for pelvic organ prolapse. Obstetrics & Gynecology. 2009. doi:10.1097/AOG.0b013e3181b2b1ae
- Nygaard I, Brubaker L, Zyczynski HM, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013. doi:10.1001/jama.2013.4919
- Barber MD, Brubaker L, Burgio KL, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014. doi:10.1001/jama.2014.1719
- Jelovsek JE, Barber MD, Brubaker L, et al. Effect of uterosacral ligament suspension vs sacrospinous ligament fixation with or without perioperative behavioral therapy for pelvic organ vaginal prolapse on surgical outcomes and prolapse symptoms at 5 years in the OPTIMAL randomized clinical trial. JAMA. 2018. doi:10.1001/jama.2018.2827
- Nager CW, Grimes CL, Nolen TL, et al. Concomitant anterior repair, preoperative prolapse severity, and anatomic prolapse outcomes after vaginal apical procedures. Female Pelvic Medicine & Reconstructive Surgery. 2019. doi:10.1097/SPV.0000000000000526
- Ferrando CA, Bradley CS, Meyn LA, et al. Twelve month outcomes of pelvic organ prolapse surgery in patients with uterovaginal or posthysterectomy vaginal prolapse enrolled in the multicenter Pelvic Floor Disorders Registry. Urogynecology. 2023. doi:10.1097/SPV.0000000000001410
- Andy UU, Meyn L, Brown HW, et al. Outcomes at 12, 24, and 36 months in women treated for pelvic organ prolapse with pessary or surgery: results from the multicenter Pelvic Floor Disorders Registry. Urogynecology. 2025. doi:10.1097/SPV.0000000000001669
- Carberry CL, Tulikangas PK, Ridgeway BM, et al. American Urogynecologic Society best practice statement: evaluation and counseling of patients with pelvic organ prolapse. Urogynecology. 2025. doi:10.1097/SPV.0000000000001641
- Chang OH, Carter Ramirez A, Edwards A, et al. The role of uterine preservation at the time of pelvic organ prolapse surgery. Urogynecology. 2025. doi:10.1097/SPV.0000000000001667
- Guérin S, Alhalabi F, Lutz K, et al. Impact of previous pelvic organ prolapse repair on outcomes of robotic-assisted mesh sacrocolpopexy. Urology. 2025. doi:10.1016/j.urology.2025.07.008
- Ashmore S, Samsel T, Collins SA, et al. Patient reported recovery after surgery. Urogynecology. 2026. doi:10.1097/SPV.0000000000001815
← Learn more about Pelvic Organ Prolapse