What is vaginal wall prolapse?
Normally, your vagina sits snugly between your bladder at the front of your body, and your bowel at the back. These organs, along with your uterus, are anchored by ligaments and supported by the connective tissue and muscles of your pelvic floor. You can think of it as a system of scaffolding that holds everything up.
When the vagina or its supporting tissues become stretched or weakened, these organs can slip out of place. This is known as a prolapse. It is a common condition that affects about half of women over the age of 50.
The most frequent cause of prolapse is pregnancy and childbirth. The problem can also appear or get worse after the menopause, when lower levels of oestrogen weaken the vagina and the tissues that hold it in place.
There are different types of prolapse, depending on which organs are affected. There are also different types of surgery. The information here is about surgery that uses your own tissue to repair:
- Anterior vaginal wall prolapse (another medical term for this condition is cystocele). This happens when your bladder pushes against the front wall of your vagina.
- Posterior wall prolapse (also called rectocele). The problem here is that your rectum is pushing against the back wall of your vagina.
If it is mild, you can have a prolapse and not be aware of any problems. However, a more advanced vaginal wall prolapse can cause troublesome symptoms, which may include:
- A feeling of heaviness in your pelvic area, as if something is dragging or dropping down
- Back pain
- Needing to pass urine more often
- Feeling unable to pass urine when you need to
- Getting frequent urine infections
- Leaking urine
- Difficulty passing a bowel movement fully
- Discomfort during sex.
Sometimes the prolapse causes a bulge that you can feel, or which can be seen sticking out from your vagina. If this happens you must see a gynaecologist to discuss treatment, to prevent possible complications.
What happens during surgery for vaginal wall prolapse?
The treatment you have will depend on the type of prolapse you are experiencing, how much the symptoms are affecting you, and whether you need or want to avoid surgery.
Pelvic floor exercises can help you feel better. However, on their own they are not likely to make the prolapse go away. Oestrogen cream might help with some of the discomfort, if the menopause is a factor. A prolapse that has progressed further will probably need additional treatment.
Sometimes vaginal prolapse can be managed with a device called a pessary. This is a piece of soft plastic that is placed in your vagina. It provides some support for the weakened tissues. A pessary must be replaced on a regular schedule. It’s often recommended for women who are not well enough to have an operation, or who want to avoid surgery if possible.
Alternatively, your gynaecologist may recommend surgery as the best choice.
Surgery for a vaginal wall prolapse is usually done under a general anaesthetic, so you sleep through the procedure. It takes around 30 minutes.
The operation is done through your vagina, without any incisions on your abdomen. Your surgeon will make a small cut in the wall of your vagina, and push your bladder or bowel back into place. They will cut away a small piece of excess tissue from your vagina, and put in some stiches. These stiches will dissolve over time. The overall effect is to tighten up the vagina and surrounding tissues, and provide some extra support.
When you wake up, you may have a catheter in place to drain your urine. Your vagina will be packed with a bandage to help reduce any swelling or bleeding. Your nurse will remove the catheter and bandage before you go home.
Depending on the details of the procedure and your individual situation, you may be able to go home the same day or you might need to stay in hospital for two or three nights.
There is usually some vaginal bleeding for two or three weeks, and you’ll be advised not to use a tampon until you have healed up from the surgery.
You will feel tired afterwards and it’s important to rest, gradually building up your activity levels (though you will be encouraged to get up and walk around soon after the operation). Returning to work and other responsibilities is an individual matter, which will depend on your fitness and the physical demands you face. Some women can gradually return to work within two or three weeks, while others will need longer to recover. It’s reasonable to plan on being back to your full activities, including having sex, around six to eight weeks after surgery.
How can surgery help with vaginal prolapse symptoms?
If nothing is done, a more advanced prolapse can get worse over time. So if the condition is already causing problems, you may decide not to delay having treatment.
The aim of surgery is to make you more comfortable, and improve the symptoms caused by having a vaginal prolapse.
What are some of the risks?
As with any surgery, there is a small risk of infection, unexpected bleeding or blood clots. Your doctor and nurses will tell you about ways to reduce your risk and what symptoms to look out for as you recover.
The vagina, bladder or bowel, or the nerves or muscles around them, could be damaged but this is uncommon.
Sometimes several organs are affected and this makes treatment more complex. For example, you might need additional strengthening surgery or a hysterectomy if your uterus is also prolapsed.
Unfortunately, some women need to have surgery again because the prolapse comes back. This happens in up to one in three cases.
Your gynaecologist will discuss the benefits and risks of your treatment options, and together you can decide on the approach that suits you best.
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