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When Things Slip: Surgical Repair for Pelvic Prolapse
A woman’s uterus is held in place in her pelvis by muscles and ligaments. However, aging, menopause and pregnancy can weaken the support, allowing the uterus to drop into the vagina. This is prolapse.
“Symptoms of pelvic prolapse range from a low backache to painful sexual intercourse and frequent urination,” says McLeod Gynecologist Dr. Brad Campbell. “In the most severe cases, a woman’s organs can appear outside her vagina.”
The collapse can put pressure on the front (anterior) wall of the pelvis where the bladder is located or on the back (posterior) wall where the rectum will be affected.
Treatment for mild cases includes losing weight and avoiding heavy lifting. Some women are fitted with a pessary (PESS-uh-ree), a rubber or plastic shaped donut that holds the organs in place. A number of prolapse patients, including about 1 in 10 women who’ve had children, require surgery.
Vaginal repair surgery has two goals: First, to improve bladder function without harming sexual function. Second, to eliminate the bulge or other visible traces of the prolapse.
Surgeons can use nearby ligaments to hold the organs in place. In the past, mesh was used to help with support of the pelvic organs. However, recent studies indicate that this mesh may have serious complications, and at this time, we no longer use mesh for pelvic organ support.
In some cases, the surgeon may recommend a hysterectomy (removal of the uterus) as part of the prolapse surgery. During the procedure, some women are also surgically fitted with a sling to control urinary incontinence, a possible side effect of prolapse surgery.
Surgery for pelvic prolapse is usually performed with so-called minimally invasive techniques. A small wand-like device (laparoscope) is inserted through the vagina or in small incisions in the abdomen. Most prolapse operations are done as same-day surgery, although some patients stay in the hospital a day or two.
Women are usually advised to take 2-6 weeks off work and should be able to drive in 3-4 weeks, depending on your doctor’s advice. Full recovery should take about 3 months, with the caution to always avoid heavy lifting.
The good news, 75-90% of women who’ve had the surgery experience a long-term cure for their condition.
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Sources include: McLeod Health, National Institutes of Health, American Urogynecological Association, International Urogynecological Association, National Health Service (UK), ObGynnews.com, Journal of Female Pelvic Medicine & Reconstructive Surgery