Alternative treatment options

For pelvic organ prolapse and stress urinary incontinence (SUI)

Non-surgical and surgical treatment options not using transvaginal mesh are available for women with pelvic organ prolapse and stress urinary continence.

Non-surgical treatments

Non-surgical treatments include:

  • pelvic floor physiotherapy – strengthening the pelvic floor through actively tightening and lifting the muscles at intervals (see a physiotherapist who specialises in pelvic floor training). Additional treatments such as electrical stimulation and biofeedback may assist with improving your pelvic floor muscle function.
  • bladder training
  • medication
  • vaginal pessary – a ring-like device that sits in the vagina helping to support the pelvic organs reducing descent and/or stress urinary incontinence. These can lead to significant improvements in prolapse symptoms and in bladder and bowel function
  • lifestyle changes – including reducing weight, avoiding heavy lifting, and treatment of constipation and chronic coughing
  • absorbent products – these can help manage incontinence problems for some women.

Surgical treatments (other than mesh)

Alternative surgical treatments include:

  • native tissue repair – where the patient’s own tissue is used to repair the prolapse
  • biological graft repair – uses a graft from a source, such as human or animal tissue, to support the vaginal prolapse
  • pubovaginal sling – using the patients own tissue
  • colposuspension – can be open or laparoscopic
  • bulking agents – these are injected into the urethra.


****** TRIGGER WARNING:  The presentation/links below include graphic images *******

Click here to view presentation by M Carey about Native Tissue Repair 2018


The presentation/links above include graphic images *******

What is a burch procedure?

Burch procedure is performed to treat urinary incontinence, and is a surgical procedure in which the neck of the bladder is suspended from nearby ligaments with sutures.

When is it used?

The Burch procedure is used when the bladder or urethra has fallen out of its normal position. The goal is to restore them to their normal position in the pelvis. This procedure should improve stress urinary incontinence, which means that you leak urine from your bladder whenever you cough, sneeze and bear down.

What are the benefits?

The procedure should allow easy, effective control of urinary function. It should help you be more active. You might be able to resume your normal level of activity without leaking urine.

What are the risks associated with this procedure?

As with any medical procedure, there are risks. Please discuss with us any additional concern you may have. The following is a list of the risks associated with the burch procedure:

  • Damage to a vein or artery that could cause serious bleeding.
  • Making a hole in your bladder that could cause a tract (fistula) between your vagina and bladder.
  • That your urine leakage may not be improved.
  • That your bulging bladder (cystocele) may not improve or could return.
  • Damage to you ureters, the tubes that carry urine from your kidneys to your bladder.
  • That you may have difficulty emptying your bladder.
  • That you may develop bulging in your rectum (rectocele) or you vagina (vaginal vault eversion).
  • That you may develop infection in your incision, the area around your bladder, or your bladder.

How do I prepare for a burch procedure?

Follow your health care provider’s instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after surgery.  Follow any other instructions your provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before midnight. Do not eat or drink after midnight.  Do not even drink coffee, tea, or water.

What happens after the procedure?

You may stay in the hospital about 1 to 2 days. However, the catheter may stay in your bladder 2 to 6 days or until your bladder is working again.

During the first 4 weeks after the operation, you may have some small, sometimes bloody drainage from your vagina. This drainage is normal and should not be a cause for concern.


Create a plan for your care and recovery after the operation, and allow plenty of time to rest. Try to find other people to help you with your day-to-day duties.

Avoid all heavy activity such as lifting for the first 2 weeks. Then follow your physician’s recommendations for gradually increasing your activity. Ask what other steps you should take and schedule follow-up visits with your health care provider.