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Prolapse

Perineal Repair and Perineoplasty

The perineum

The perineum is the skin and muscle in the area between the vaginal opening and the anus (back passage). This area becomes weak and the muscles can be divided during childbirth. There is a loss of sensation at penetration for intercourse and thus reduced satisfaction for both partners.

What is Perineal Repair/Reconstruction?

This procedure typically tightens the muscles between the vagina and anus (back passage) that are often divided during childbirth. The stretched muscles at the back of the vagina are joined together and shortened with dissolvable stitches, and the excess skin removed.

How long does the surgery take?

The surgery takes about 45 minutes to one hour to perform under general anaesthetic and usually involves an overnight/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 2 weeks. You will be able to walk the day after surgery and return to 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 3 weeks after surgery.

What can I expect from the surgery?

Surgery tightens the entrance to the vagina and increases the resistance on penetration and friction felt on intercourse.

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.

Having a vaginal hysterectomy

This leaflet provides some information about having a vaginal hysterectomy. The treatment described here may be adapted to meet your individual medical needs, so it’s important to follow your surgeon’s advice.

Please raise any concerns or questions with your surgeon or nurse. It is natural to feel anxious before hospital treatment but knowing what to expect can help.

What is a hysterectomy?

A hysterectomy is an operation to remove the uterus (womb). The operation, may also involve removing one or both of the fallopian tubes and one or both of the ovaries, depending on which condition is being treated.

There are a number of reasons for having a hysterectomy. Sometimes women who have very painful or heavy periods decide to have their uterus removed because this will stop the bleeding for good. Women who have cancer of the uterus or cervix often need a hysterectomy.

A vaginal hysterectomy involves removing the uterus through the vagina. It is performed under general anaesthesia, which means you will be asleep during the procedure.

The procedure usually requires a hospital stay of two to four days. Your surgeon will explain the benefits and risks of having a vaginal hysterectomy, and also will discuss the alternative procedures.

Preparing for your operation

The hospital will send you a pre-admission questionnaire. Your answers help hospital staff to plan your care by taking into account your medical history any previous experience of hospital treatment.

If you normally take medication (e.g. tablets for blood pressure), continue to take this as normal, unless your surgeon or anaesthetist specifically tells you not to. If you are unsure about taking the medication please contact us.

Before you come into hospital, you will be asked to follow some instructions.

  1. Have a bath or shower at home on the day of your admission.
  2. Remove any make-up, nail varnish and jewellery. Rings and earrings that you’d prefer not to remove can usually be covered with sticky tape.
  3. Follow the fasting instruction in your admission confirmation letter. Typically, you must not have anything to eat or drink for about six hours before your general anaesthesia. However, some anaesthetists allow occasional sips of water until two hours beforehand.

When you arrive at the hospital a nurse will explain how you will be cared for during your stay, and many do some simple tests such as measuring your heart rate and blood pressure, and testing your urine. Your surgeon and anaesthetist will also visit you to discuss the operation. This is a good time to ask any unanswered questions.

Your nurse will then help you prepare for theatre. You will be asked to wear compression stockings to help prevent blood clots forming in the veins of your legs. An injection of an anti-clotting medicine called Heprin may be given as well as, or instead of, stockings.

You may be given a laxative to help you go to the toilet before the operation. You may also be given an antibiotic to help reduce the chance of getting an infection after the operation. This is usually given at the same time as the anaesthetic.

Consent

If you are happy to proceed with the operation, you will be asked to sign a consent form. This confirms that you have given permission for the procedure to go ahead. You need to know about the possible side-effects and complications of this procedure in order to give your consent. Please continue to read for more information.

About the operation

Once the anaesthetic has taken effect, your surgeon will make a cut (incision) to separate the vagina from the neck of the womb. Then your surgeon will remove the womb through the opening of the vagina. The cut is sewn up using dissolvable stitches. This technique leaves no visible scars and usually takes an hour.

After your operation

You will be taken from the operating theatre to a recovery room, where you will come round from the anaesthesia under close supervision.

After this, you will be taken back to your room where a nurse will assess the operation site and monitor your heart rate and blood pressure. You will be wearing a sanitary towel to absorb any vaginal bleeding, which is similar to a light period.

Back on the ward

You will need to rest until the effects of the anaesthesia have passed. Your anaesthetist will prescribe painkillers for the first few days after the operation. Suffering from pain could slow down your recovery, so please tell the doctors or nurses if you feel that the pain is uncontrolled.

There will be a drip in your arm to keep you hydrated. This will be removed when you can drink enough fluid. When you feel ready, you can begin to drink and eat starting with clear fluids.

The catheter is usually taken out in the first day or two. You may feel uncomfortable to begin with and have sudden urges to urinate, some dribbling or difficulty emptying your bladder. This should pass within 24 hours.

You may find that you don’t open your bowels for up to five days after the operation. However, you should try not to strain when you go to the toilet as this can stretch the healing wound. Laxatives will be available if you need them.

Your nurse will give you advice about getting out of bed, bathing and diet. A physiotherapist will explain some exercises that you can do at home to help speed up your recovery.

The clips or stitches will be removed on about the fifth day after the operation. If dissolvable stitches have been used they will disappear on their own in seven to ten days.

Going home

Your surgeon will answer any questions that you have before you go home. Your nurse will give you a contact telephone number for the hospital and will arrange a follow up appointment for you in about six weeks.

After you return home

You will need to take it easy and should expect to tire easily at first. Avoid strenuous exercise and lifting. You must follow your surgeon’s advice about driving. You shouldn’t drive until you are confident that you can perform an emergency stop without discomfort.

It is normal to have some blood-stained vaginal discharge for about six weeks after surgery. Follow your surgeon’s advice about using sanitary towels rather than tampons. If the bleeding becomes bright red, heavy or smells unpleasant, contact the hospital as you may have a damaged blood vessel or an infection.

Your surgeon will advise you when you can resume normal activities. A full recovery can take up to 12 weeks

What are the risks?

A hysterectomy is commonly performed and generally a safe operation. However, all surgery carries an element of risk. This can be divided into the risk of side-effects and the risk of complications.

Side-effects

These are the unwanted, but mostly temporary effects of a successful treatment. An example of a side-effect is feeling sick as a result of the anaesthetic or painkillers. Medicines are available to help avoid this. Another common side-effect of hysterectomy is some pain and discomfort.

It is natural to worry that a hysterectomy might affect your sex life. This is not necessarily the case and depends on a number of factors including the exact operation that you have.

Conditions that may need to be treated by hysterectomy (such as heavy menstrual bleeding) may reduce a women’s sexual enjoyment. So some women often find that their sex life improves after the hysterectomy. Talk to your surgeon if you are worried about this.
If your ovaries have been removed, you may get menopausal symptoms after the operation such as hot flushes and vaginal dryness. Your doctor may recommend hormone replacement therapy to help with this. If sex is painful because your vagina is dry, you may find that lubricants (available at most chemists) are helpful.

Complications

This is when problems occur during or after the operation. Most women are not affected. The main possible complications of any surgery include an unexpected reaction to the anaesthesia, excessive bleeding, infection, or developing a blood clot in the vein in the leg (deep vein thrombosis or DVT).

Specific complications of hysterectomy are uncommon but can include damage to other organs and tissue in the abdomen, particularly the bladder and ureters (tubes that carry urine from the kidneys to the bladder). These complications may need further treatment such as returning to theatre to stop bleeding or repair a damaged ureter, antibiotics to treat an infection, or a larger incision during the operation to repair a damaged organ.

The chances of complications depend on the exact type of operation you’re having and other factors such as your general health. Ask your surgeon to explain how these risks apply to you.
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