Prolapse or Pelvic Floor Reconstruction

What is a Prolapse?

A prolapse or more correctly, Pelvic Organ Prolapse, is a medical condition where an organ or tissue falls or slips from its normal position and protrudes from the vaginal opening. This occurs when the vaginal connective tissue that supports the pelvic organs is weakened or stretched.

Types of Pelvic Organ Prolapse

There are different types of pelvic organ prolapse, such as

• Rectocele - rectum protrudes into the vagina
• Cystocele - bladder protrudes into the vagina
• Enterocoele - small bowel protrudes into the vagina
• Uterine prolapse - uterus and cervix protrude into the vagina
• Vaginal Vault prolapse - vaginal apex herniates into vagina

Pelvic organ prolapse is diagnosed by performing a physical examination, including a pelvic examination, and you may need other tests such as cystoscopy or an ultrasound scan.

Treatments for Pelvic Prolapse

Treatment options include

• Pelvic floor exercises
• Lifestyle changes - to avoid heavy lifting, constipation, obesity
• Local oestrogen treatment
• A pessary is 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. Several types of surgery are available to correct different types of pelvic floor prolapse. The surgery is usually performed through the vagina and sometimes laparoscopically or through an abdominal incision, depending on the nature of the prolapse.

Surgical treatment for pelvic organ prolapse

There are different types of procedures to address a specific prolapse. Pelvic floor reconstruction aims to restore the normal anatomy and function of the pelvic organs.

Dr Turner does not use mesh in his repairs. There is up to a (20%) recurrence risk after prolapse repair, and hopefully, the pelvic mesh was introduced to reduce that risk. Unfortunately, it turned out that the mesh was associated with severe complications, including chronic pain. Pelvic mesh is now banned in Australia and is no longer in use.

Anterior Repair

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.

Posterior Repair

This is a vaginal procedure to treat a rectocele. The posterior vaginal wall is opened to reveal the rectal prolapse. The prolapse is reduced, and dissolving sutures are placed in the fascia holding the rectum in place. The vaginal skin is closed with a rapidly absorbing suture.

Perineorrhaphy

This is a vaginal procedure performed to treat a gaping vaginal opening. It is often done with a posterior repair. A small incision is made at the posterior introitus, and minimal dissection is performed at the perineum. Sutures are placed on building up the perineal body and treat the gaping introitus.

Hysterectomy

When there is prolapse of the uterus, a hysterectomy is often done. A McCall suture can be done simultaneously to attach the top of the vagina higher up to the uterosacral ligaments.

Sacrospinous Ligament Fixation

This is a vaginal procedure to elevate the vaginal apex to the sacrospinous ligaments. It is performed in conjunction with an anterior or posterior repair.

Complications of Vaginal Prolapse Surgery

There are risks with all surgical procedures.

The possible complications after the surgery for vaginal prolapse include

• pain
• infection
• bleeding
• recurrence of symptoms
• injury to ureters, rectum or bladder.
• recurrence of the prolapse
• Difficulty with intercourse
• Unmasking urinary stress incontinence

Most complications are usually mild and can be treated accordingly.

Recovery After Prolapse Surgery

• Usually, 3-5 days are required in the hospital after the procedure. You will have a catheter in your bladder which will be removed the next day. Usually, a vaginal pack [like a large tampon] is inserted in the vagina at the end of the procedure and removed the next day. Most women will require some form of oral analgesia for about one week.
• Constipation is very common after pelvic floor repair procedures. We will give specific advice to help you to address this problem.
• You must avoid heavy lifting and strain for at least three months.
• a physiotherapist will review you 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.
• Often it is recommended to use an oestrogen cream known to enhance tissue strength and promote healing.