What is a Prolapse?
A prolapse is a medical condition where an organ or tissue falls down or slips from its normal position. This occurs when the pelvic floor muscles and connective tissue that support the pelvic organs are weakened.
A pelvic organ prolapse is a condition that occurs when the structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself falls out from their normal position.
Causes of Vaginal Prolapse
The main cause of vaginal prolapse is the weak muscles, tissues, and ligaments that support the vagina, surrounding tissues and organs.
The factors that can cause vaginal prolapse include
childbirth,
menopause,
frequent lifting of heavy objects,
chronic cough,
severe constipation.
Symptoms of Utero-Vaginal Prolapse
A woman with a mild prolapse may not experience any symptoms. However, women with more severe forms of prolapse may experience:
Sensation of pulling or pressure in the lower abdomen or pelvis
An uncomfortable feeling of fullness in the vagina
Low back pain
Urinary problems, such as urine leakage or urine retention
Difficulty in urinating and emptying bowel
Urinary tract infections
Vaginal bleeding or discharge
Discomfort during intercourse
Diagnosis of Utero-Vaginal Prolapse
Dr Mariud will diagnose the condition by taking a detailed history and performing a physical examination. During the examination, you may be asked to cough or bear down.
Treatments for Pelvic Prolapse
Treatment options include
Pelvic floor exercises
Lifestyle changes - to avoid heavy lifting, constipation
Local oestrogen treatment
Pessary, a removable device fitted in the vagina to reduce pain and pressure of pelvic organ prolapse.
If the non-surgical treatment does not reduce the symptoms of pelvic organ prolapse, then surgery is considered. There are several types of surgeries to correct different types of pelvic floor prolapse.
The surgery can be performed laparoscopically or through the vagina, depending on the nature of the prolapse.
Surgical Treatments for Pelvic Floor Disorders
There are different types of procedures to address a specific prolapse. The aim of pelvic floor reconstruction is to restore normal anatomy and function of the pelvic organs.
Dr Mariud will discuss with you the laparoscopic surgical options such as
Laparoscopic Pelvic Repair, and
Vaginal Pelvic Floor Repair.
Dr Mariud has expertise on pelvic floor repair.
ANTERIOR COLPORRHAPHY
This is a vaginal procedure to address a moderate degree of cystocele. The anterior vaginal wall is opened to reveal the bladder prolapse. The prolapse is reduced and held in place with a ladder of slowly absorbing sutures. The vaginal skin is closed with a rapidly absorbing suture. This procedure takes about30 minutes to perform. You will be in hospital overnight. You will return to normal activities after about 2-3 weeks. Dr Mariud will see you one week after discharge from hospital to monitor your progress.
POSTERIOR COLPORRHAPHY
This is a vaginal procedure to address a moderate degree of rectocele. The posterior vaginal wall is opened to reveal the rectal prolapse. The prolapse is reduced and held in place with a ladder of slowly absorbing sutures. The vaginal skin is closed with a rapidly absorbing suture. This procedure takes about30 minutes to perform. You will be in hospital overnight. You will return to normal activities after about 2-3 weeks. Dr Mariud will see you one week after discharge from hospital to monitor your progress.
PERINEORRAPHY
This is a vaginal procedure performed to treat a gaping introitus. A small incision is made at the posterior introitus and minimal dissection performed at the perineum. Sutures are placed to build up the perineal body and treat the gaping introitus.
This procedure takes about30 minutes to perform. You will be in hospital overnight. You will return to normal activities after about one week. Dr Mariud will see you one week after discharge from hospital to monitor your progress.
SACROSPINOUS COLPOPEXY
This is a vaginal procedure to elevate the vaginal apex to the sacrospinous ligaments. It is performed in conjunction with a posterior colporraphy. It takes about 45 minutes to perform. You will be in hospital for two days. You will return to normal activities after about 2-3 weeks. Dr Mariud will see you one week after discharge from hospital to monitor your progress.
Complications of Vaginal Prolapse Surgery
Every surgical procedure may be associated with certain risks and complications. The possible complications after the surgeries for vaginal prolapse include pain, infection, bleeding, recurrence of symptoms, injury to ureters, and perforation of rectum and bladder.
The complications are usually mild and can be treated accordingly.
The advantages of choosing minimally invasive surgery is that the defects can be clearly identified, incisions are small, postoperative pain and discomfort are reduced, shorter duration in hospital, and quicker recovery.
Post Operative Expectations
Most women will require some form of oral analgaesia for about one week. Constipation is very common after pelvic floor repair procedures.
Dr Mariud will give specific advice to help you to address this problem. You are advised to avoid heavy lifting and straining for at least 3 months.
Dr Mariud will arrange for you to be reviewed by physiotherapist with a special interest in pelvic floor disorders. Ongoing pelvic floor exercises and lifestyle modifications to avoid heavy lifting will ensure a long term cure.
Dr Mariud may also recommend ongoing use of an oestrogen cream which is known to enhance tissue strength and promote healing.
Prolapse Surgery
What is Prolapse Surgery?
Prolapse surgery is a procedure used to correct pelvic organ prolapse. In this condition, one or more pelvic organs, such as the bladder, uterus, rectum, or bowel, drop from their normal position due to weakened or damaged muscles and ligaments that support them. This can cause discomfort, pain, and other symptoms such as urinary or bowel incontinence, pressure in the pelvic area, or difficulty with sexual intercourse. Prolapse surgery aims to restore the organs to their normal position, relieving symptoms and improving the patient's quality of life.
Who is Suitable for Prolapse Surgery?
Prolapse surgery is typically recommended for patients who:
Experience significant symptoms affecting their quality of life, such as pelvic pressure, discomfort, or bladder and bowel function difficulty.
Have tried non-surgical treatments like pelvic floor exercises, pessaries (devices inserted into the vagina to support the pelvic organs), or lifestyle changes, but these have not provided sufficient relief.
Are in generally good health and able to tolerate surgery and the recovery process.
Have a desire for long-term relief from symptoms and are not planning future pregnancies (as pregnancy can place additional strain on pelvic organs).
Benefits of Prolapse Surgery
The benefits of prolapse surgery can include:
Symptom relief: The surgery can effectively relieve pelvic discomfort, pressure, or a bulging sensation.
Improved bladder and bowel function: Many patients experience improved control over urinary and bowel function, reducing incontinence or urgency.
Enhanced sexual function: Restoring the pelvic organs to their proper position may improve comfort during intercourse.
Long-term results: For many patients, prolapse surgery offers lasting relief from their symptoms.
Improved quality of life: Overall, prolapse surgery can significantly enhance daily living by reducing the discomfort and limitations caused by pelvic organ prolapse.
Types of Prolapse Surgery
There are several types of prolapse surgery, each targeting different forms of pelvic organ prolapse:
Anterior Colporrhaphy (Bladder Prolapse Repair): This surgery repairs a prolapsed bladder (cystocele). It involves tightening the front wall of the vagina to support the bladder and prevent it from dropping down into the vaginal canal.
Posterior Colporrhaphy (Rectal Prolapse Repair): This procedure addresses rectal prolapse (rectocele) by tightening the back wall of the vagina, which supports the rectum.
Uterine Prolapse Surgery (Hysterectomy or Uterine Suspension): For uterine prolapse, surgery may involve removing the uterus (hysterectomy) or suspending the uterus back into place using supportive tissues or mesh.
Vaginal Vault Suspension: After a hysterectomy, some women may experience prolapse of the vaginal vault (the top of the vaginal canal). Vaginal vault suspension can be done using a person's own tissue or synthetic mesh to lift and secure the vaginal vault.
Sacral Colpopexy: In this procedure, a surgical mesh is attached to the vagina and sacrum (the lower spine) to support the vagina, commonly used in more complex cases or after hysterectomy.
Perineorrhaphy: This involves repairing the perineum (the area between the vagina and anus) to improve pelvic floor support.
Alternative Options to Prolapse Surgery
Not all cases of pelvic organ prolapse require surgery, and there are several non-surgical alternatives available, including:
Pelvic Floor Exercises (Kegel Exercises): Strengthening the pelvic floor muscles through exercises can help reduce mild prolapse symptoms. These exercises involve contracting and relaxing the muscles that support the pelvic organs.
Pessary Devices: A pessary is a silicone or plastic device that is inserted into the vagina to support the pelvic organs and keep them in place. It is a non-invasive option that can provide relief from symptoms without the need for surgery. Pessaries come in different shapes and sizes and can be fitted by a healthcare provider.
Lifestyle Changes: Managing factors contributing to prolapse, such as chronic coughing, constipation, or being overweight, can help relieve symptoms. Lifestyle modifications such as a high-fibre diet, maintaining a healthy weight, and avoiding heavy lifting can reduce strain on the pelvic organs.
Hormone Replacement Therapy (HRT): For postmenopausal women, vaginal oestrogen therapy may help strengthen the tissues supporting the pelvic organs and reduce prolapse symptoms.
Physical Therapy: Pelvic floor physical therapy involves working with a specialist who can teach specific exercises and techniques to improve pelvic muscle strength and reduce prolapse symptoms.
Observation and Monitoring: Some patients may choose to monitor their symptoms and delay surgery in mild prolapse cases. This option involves regular check-ups to ensure the condition does not worsen.
What to Do Before a Prolapse Surgery?
Before undergoing prolapse surgery, careful preparation is important to ensure the best outcome.
Consultation and Assessment: Meet your healthcare provider to evaluate your condition thoroughly. This includes discussing your symptoms, medical history, and overall health. Your doctor may perform a physical examination and request diagnostic tests, such as pelvic imaging, to confirm the severity of the prolapse and determine the appropriate type of surgery.
Understand the Procedure: Discuss the surgery details with your surgeon, including what type of prolapse surgery you will have, the risks involved, and the expected outcomes. It’s important to address any concerns and clearly understand the benefits and potential complications of the surgery.
Lifestyle Adjustments: Your doctor may recommend lifestyle changes to prepare your body for surgery. This may include:
Quitting smoking
Managing weight
Improving diet
Pelvic floor exercises
Preoperative Instructions: Your doctor will provide specific instructions to follow before surgery, including:
Fasting: You may need to stop eating and drinking for several hours before the surgery.
Medication adjustments: Inform your doctor about any medications, supplements, or herbal products you are taking. Some medications, like blood thinners, may need to be stopped or adjusted before surgery.
Arranging for help: Since you may need assistance after the surgery, it’s a good idea to arrange for someone to help you with transportation and daily activities during the initial recovery period.
Prolapse Surgery Procedure
Here’s what typically happens during the surgery:
Anaesthesia: You will receive anaesthesia to ensure you are comfortable and pain-free during the surgery. General anaesthesia will make you unconscious, while regional anaesthesia (like spinal or epidural anaesthesia) will numb the lower part of your body.
Surgical Approach: The surgeon will decide on the best surgical approach based on the type and severity of the prolapse. There are different methods to correct prolapse:
Vaginal Approach: This is done through the vagina without the need for external incisions. It’s commonly used for bladder or uterine prolapse.
Laparoscopic Approach: This minimally invasive technique involves small incisions in the abdomen through which a camera and surgical instruments are inserted. The surgeon repairs the prolapse while viewing the internal organs on a screen.
Open Surgery: An open abdominal incision may sometimes be required, especially for more complex prolapses or other conditions.
Tissue Repair: The prolapsed organ returns to its normal position, reinforcing the surrounding tissues. The surgeon may use stitches, synthetic mesh, or the patient’s tissue to support the organs. For example:
For bladder prolapse, the front wall of the vagina may be repaired.
For rectal prolapse, the back wall of the vagina may be tightened.
For uterine prolapse, a hysterectomy (removal of the uterus) or uterine suspension may be performed.
For vaginal vault prolapse, the surgeon may use mesh to support the vaginal walls.
Closing Incisions: Once the prolapse has been corrected, the incisions are closed with stitches, and the area is bandaged. If laparoscopic surgery is used, the small abdominal incisions will be sutured or glued shut.
What to Expect After a Prolapse Surgery?
After prolapse surgery, the recovery process begins immediately. You will wake up in a recovery room, where medical staff will monitor your vital signs and manage any initial discomfort. The anaesthesia may make you dizzy or disoriented, but this will wear off in a few hours.
Depending on the type of surgery, you may need to stay in the hospital for 1–2 days. Minimally invasive procedures, like laparoscopic surgery, often allow for a shorter hospital stay compared to open surgeries.
Prolapse Surgery Recovery Plan
Recovery from prolapse surgery is a gradual process, and following a clear recovery plan is essential for a successful outcome.
Rest and Recuperation: Rest is crucial in the initial weeks after surgery. Avoid activities that pressure the pelvic area, such as heavy lifting, strenuous exercise, or standing for long periods.
Pelvic Floor Exercises: Once your doctor approves, you can resume or begin pelvic floor exercises to help strengthen the muscles supporting your pelvic organs. This will reduce the risk of prolapse recurrence.
Managing Pain: Take pain medications as prescribed to manage discomfort. Some patients may only need over-the-counter pain relievers after a few days, while others may need stronger prescription pain relief initially.
Avoiding Constipation: Preventing constipation is important after prolapse surgery, as straining during bowel movements can stress the pelvic area. A high-fibre diet, plenty of fluids, and stool softeners are recommended.
Follow-Up Appointments: Your doctor will schedule follow-up appointments to monitor your healing and address concerns. The doctor will check the surgical site during these visits to ensure proper healing.
Sexual Activity: Avoid sexual intercourse for at least 6–8 weeks after prolapse surgery, or as directed by your doctor, to give the pelvic tissues adequate time to heal.
Gradual Return to Activity: You can gradually return to normal activities over a few weeks. Start with light activities and avoid any exercises that involve abdominal pressure or impact, such as running, for at least 6–8 weeks.
Long-Term Lifestyle Adjustments: Maintaining a healthy lifestyle prevents future prolapse. This may include:
Maintaining a healthy weight.
Continuing with pelvic floor exercises.
Avoiding heavy lifting or high-impact exercises.
Preventing and managing chronic conditions such as constipation or coughing.
Prolapse Surgery Prognosis
The prognosis for prolapse surgery is generally positive. Most patients experience significant relief from symptoms and an improved quality of life after surgery. Many patients report reduced discomfort, better bladder and bowel function, and improved sexual function.
Prolapse Surgery Risks
Common risks include:
Infection
Bleeding
Pain and Discomfort
Urinary or Bowel Issues
Damage to Surrounding Organs
Prolapse Recurrence
Mesh Complications (if mesh is used)
Blood Clots
What if Prolapse Surgery is Delayed?
Delaying surgery in more severe cases or when symptoms worsen can lead to several potential consequences:
Worsening of Symptoms
Impact on Daily Life
Increased Risk of Urinary Incontinence
Strain on Other Pelvic Organs
Difficulty with Future Surgery
Psychological Effects
While delaying surgery may be suitable for mild cases, it’s important to work closely with a healthcare provider to monitor the condition and determine the right time for intervention.
Cost of Prolapse Surgery
On average, the out-of-pocket cost of prolapse surgery in the private system varies, depending on the specifics of the surgery and hospital charges. If mesh or additional procedures are involved, the cost may increase.
If you have private health insurance, some or all hospital and surgeon fees may be covered, depending on your policy. It’s essential to check with your insurance provider to understand what is covered and if there are any out-of-pocket expenses.
Before proceeding with surgery, discuss the costs with your healthcare provider, obtain a written estimate, and confirm coverage with your insurance company, if applicable. This will help you avoid any unexpected expenses.