Yup. Very much aware of the potential downsides of surgery. Have done some fairly extensive research into the topic, including looking at best practise from various different countries.
As you say, surgery can be beneficial for some, but has a relatively low long term success rate, and a fairly challenging recovery process.
For some people it will be the right option because their position pre surgery will be such that the potential benefits outweigh the potential risks.
However, many won’t be at that point with impact of symptoms on their day to day life. Surgery is misunderstood by many as being some magic wand that just involves being knocked out and a few weeks of quiet in the sofa and then fully fixed forever. That works for appendixes, and knee replacements, and pinning broken ankles. But not for rebuilding the soft structures that support internal organs.
So, I think we’re in violent agreement that surgery shouldn’t be anyone’s first port of call. That would logically suggest that anyone whos in the ‘might one day’ category for prolapse surgery would benefit from taking as many steps as possible in order to prevent reaching point of needing surgery.
Which is where your other tactics come in.
Eg. Specialist physio, who can a) assess your current pelvic floor strength and tone, and provide advice on either maintaining or improving depending on your starting point and b) give you personalised lifestyle advice to minimise downward pressure that could worsen the prolapse over time c) bladder and bowel movement management to reduce likelihood of other issues.
Eg. A pessary to help provide support, either all day every day, or for specific activities. In the same way people use wrist or knee braces, or physio tape on joints. Sometimes for more challenging activities, sometimes for day to day.
Eg. Topical oestrogen to help protect tissue, or moisturiser.
Those all have very, very low likelihood of a negative outcome. So the benefit vs risk swings massively the other direction and makes them good options to consider for many people.
Or, you’re right. Could do absolutely nothing and ignore it and hope for the best.