What are prolapse treatments?
A variety of different procedures can be done to correct prolapse.
Vaginal surgeries are more common. The vaginal wall is opened, layers between the vagina and the bladder or bowel are dissected and then sutured back in place to provide support, and then the vaginal wall is repaired. No mesh is used; rather, long lasting dissolving stitches provide support while the vaginal wall heals.
Sometimes a permanent stitch might be used to support the upper vagina. Some women will require a hysterectomy but most do not.
Laparoscopic surgeries can also be done. These are completed through small cuts on the abdomen, through which fine instruments are introduced. These allow precise placement of supporting sutures, usually to elevate the uterus and cervix back into the upper vagina, and sometimes to correct support problems for the front wall of the vagina.
In women who have had a hysterectomy and where the upper vagina has lost support, a laparoscopic mesh repair may sometimes provide the best long-term result. This is complex surgery and a detailed discussion including the non-mesh options is provided.
Prolapse surgery is not designed to correct urinary incontinence, although the surgeries can be combined.
When is prolapse surgery performed?
Ideally after conservative options such as lifestyle change, weight loss and pelvic floor training have been undertaken. Some women may use a support pessary for some time before deciding to have surgery.
You should be careful that your recovery can allow several months of reduced lifting and exercise, as the tissues that have been sutured to correct the prolapse take nearly 12 months to completely heal. Women with young children or who are engaged in heavy lifting, high-impact sports, or involved in caring for a loved one should be cautious.
Research suggests around 1 in 5 women who have a prolapse repair end up needing a second procedure. We place a lot of emphasis on the recovery and optimising the right time for surgery.
Some women are worried their prolapse may get worse and that they should have an operation sooner rather than later. However, there is no good research to support ‘early intervention’, and the type of surgery doesn’t really vary if the prolapse gets a little worse.
How is it the procedure performed?
Location: At Wakefield Private Hospital
Anaesthetic: General, or sometimes a spinal
Duration of the operation: Between 1-2 hours for most surgeries
What can I expect after the operation?
When you wake up: You will have an IV line in your arm or hand. You will have a catheter in the bladder and (if you have had vaginal surgery) a pack in the vagina – this is like a big tampon, putting pressure on the incisions to prevent swelling. You will be able to eat and drink as you wish.
You will have some compression devices on your calves until the following morning, when the pack and catheter will be removed and you will be encouraged to get up and about. Local anaesthetic is used liberally; most women do not need a lot of strong pain relief.
Nights in hospital: Usually 1-2 nights.
Time off work: Depends a lot on the nature of your work, but usually at least 3. You should avoid lifting anything heavier than 5kg for the first 6-8 weeks, and not more than 10-12kg for 2 months after that. More advice about recovery is given before your surgery.
Back to normal functioning: Driving may be 2-3 weeks away. For vaginal surgeries we suggest waiting on penetrative sex until we have seen you for followup. Avoid baths/spas/swimming for 4 weeks. If you have been on vaginal estrogen cream, continue this in your recovery.
Usually occurs 6 weeks after surgery.
Our nurse will contact you a few days after surgery to check how things are going.
- Your Pelvic Floor - Conditions
- Urogynaecological Society of Australasia - Hysterectomy, Vaginal Repair and Apical Suspension (PDF)
- Australian Commission on Safety and Quality in Healthcare - Treatment options for Pelvic Organ Prolapse (PDF)
- Royal College of Obstetricians and Gynaecologists - Pelvic floor repair operation