Pelvic floor reconstruction
Many women suffer from the symptoms of vaginal prolapse or relaxation. The symptoms can vary from an uncomfortable feeling in the vaginal area, altered bowel emptying, lack of sensation on intercourse to incontinence of urine on coughing or sneezing. These symptoms relate to a combination of the effect of childbirth, age or inherited weakness of the support structures of the vagina and are termed “prolapse”. Prolapse can occur at any age and is usually associated with vaginal deliveries.
Some degrees of prolapse do not need surgery and can be successfully managed by physiotherapy. The organs are usually held in position by supporting tissues termed fascia, ligaments and muscle termed the pelvic floor. The organs that have slipped out of place into the vagina vary from woman to woman and thus the operative procedure required will vary. If the bladder has prolapsed this is termed a cystocele. The bladder lies on the anterior wall of the vagina. If the bowel has bulged in to the vagina it is termed a rectocele. The uterus (womb) may also protrude lower than normal.
What does the surgery involve?
This procedure typically tones vaginal muscle resulting in greater strength, contraction and control. Pelvic floor reconstruction is a surgical procedure that your surgeon would have undertaken many times.
The stretched muscles at the back of the vagina are joined together and shortened with dissolvable stitches, and the excess skin removed. This tightens the vaginal muscles and surrounding soft tissues by reducing the excess vaginal skin. The cuts and healing are on the inside of the vagina. If the bladder has sagged then the excess skin is excised, the bladder is repositioned above the pelvic floor muscles and held in place by stitches.
If the muscle between the vagina and back passage (anus) are weak these may also be strengthened in a procedure similar to the repair that is undertaken if you have a tear or cut (episiotomy) at vaginal delivery. Sometimes the womb has slipped out of place and it is necessary to repair the womb by a procedure termed a Manchester or Fothergill repair. These operations are performed if it is important that the uterus is maintained such as when you would like to have another child. Occasionally the womb has fallen so far down it needs to be removed vaginally.
How long does the surgery take?
The surgery takes about one hour to perform under general anaesthetic and usually involves an overnight to 2-day stay.
What will happen in the recovery phase?
You will be a little sore and possibly swollen after the surgery but this discomfort usually settles within days. You will be able to walk the day after surgery and return to work and sexual activity around six weeks following a satisfactory follow-up consultation.
What is the recovery time?
Recovery is quite quick and you will have resumed most of our normal activities 2 – 3 weeks after surgery. You will feel tired however for up to 6 weeks.
What can I expect from the surgery?
The uncomfortable feeling from the bulge of organs in to the vagina will be removed. If you have had some incontinence of urine then this should also resolve provided the incontinence is due to the bladder slipping out of place.
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