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Vaginal Prolapse Surgery

By

Catherine Spader, RN

What is vaginal prolapse surgery?

Vaginal prolapse surgery includes various procedures to correct weak or damaged muscles, ligaments and tissues that hold a woman’s pelvic organs in place. Problems with this support system, called the pelvic floor, are common in women who have had children. Vaginal prolapse causes protrusion of the pelvic organs into the vagina, which can lead to urinary incontinence and other problems. 

Vaginal prolapse surgery is a major surgery with serious risks and potential complications. You may have less invasive treatment options depending on your circumstances. Consider getting a second opinion about all of your treatment choices before having vaginal prolapse surgery. 

Types of vaginal prolapse surgery

Vaginal prolapse is a condition in which a pelvic organ slips out of its normal place and protrudes into the vagina. Often, two or more pelvic organs are prolapsed, including the bladder, rectum, bowel, uterus, and vaginal vault (upper portion of the vagina). As a result, multiple procedures may be necessary. 

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There are many types of vaginal prolapse surgery, also called pelvic organ prolapse surgery and pelvic reconstructive surgery for pelvic organ prolapse. Common examples of vaginal prolapse surgery include:

  • Colporrhaphy treats a prolapsed bladder (cystocele) or rectum (rectocele) by repairing the weakened wall between the vagina and the bladder or rectum. The surgery is performed through the vagina.

  • Hysterectomy treats a prolapsed uterus by removing it.

  • Uterine suspension treats a prolapsed uterus by shortening stretched-out ligaments that support the uterus. Another version suspends the uterus by supporting it with mesh, which is attached to the pelvis.

  • Vaginal vault suspension treats a prolapse of the upper part of the vagina (vaginal vault) by attaching it to strong ligaments toward the back of pelvis. Another version lifts the vaginal vault by supporting it with mesh, which is attached to the pelvis.

Vaginal vault suspension can also treat a uterus, bladder, or small bowel that has slipped out of place due to a weakness in the vaginal wall.

Why is vaginal prolapse surgery performed? 

Your doctor may recommend vaginal prolapse surgery to repair or correct weaken or damaged muscles, ligaments and tissues that hold your pelvic organs in place. Problems with this support system, called the pelvic floor, can result in prolapse of the bladder (cystocele), rectum (rectocele), bowel (enterocele), uterus, and vaginal vault (upper part of the vagina). This is common in women who have had children.

Doctors generally recommend vaginal prolapse surgery when your symptoms are severe enough to interfere with your daily life. 

Symptoms of vaginal prolapse include:  

  • A mass or protrusion from the vagina

  • Difficulty having bowel movements

  • Pain with sex

  • Pelvic or back pressure or pain

  • Urinary problems including stress incontinence or difficulty passing urine

Vaginal prolapse is associated with the following conditions:

  • Aging and menopause

  • Hysterectomy

  • Long-term coughing

  • Obesity

  • Ongoing constipation

  • Prolonged labor or having a large baby

  • Repeated childbirth or having a multiple birth, such as twins or triplets

  • Smoking

Your doctor may only consider vaginal prolapse surgery for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on vaginal prolapse surgery.

Who performs vaginal prolapse surgery?

The following specialists perform vaginal prolapse surgery:

  • Obstetrician-gynecologists specialize in women’s health and pregnancy.

  • Urologists specialize in diseases and conditions of the urinary tract and the male reproductive organs.

  • Female pelvic medicine and reconstructive surgeons are urologists or gynecologists who have completed specialized training in women’s pelvic floor disorders.

How is vaginal prolapse surgery performed?

Your vaginal prolapse surgery will be performed in a hospital or surgery clinic. The procedure varies depending on the type and severity of your vaginal prolapse and other factors. Your doctor will perform vaginal prolapse surgery using one of the following approaches:

  • Minimally invasive surgery uses a laparoscope, which is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your surgeon will insert a laparoscope and special instruments through small incisions in the lower abdomen to perform the surgery. Your surgeon may also use a surgical robotic system for laparoscopic vaginal prolapse surgery. Your surgeon directs a robotic device from a computer to perform many steps of the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.

  • Open surgery allows your surgeon to directly view and access the inside of your body. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

  • Vaginal approach involves repairing your vaginal prolapse through the vagina. Your surgeon inserts a speculum into the vagina to hold it open and repairs the damage or weakness in the vaginal wall. This procedure does not require an incision into the abdomen and has a quicker recovery. It is not appropriate for all types of vaginal prolapse surgery.

Your doctor will advise you on which procedure is best for you and how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used

Your doctor will perform vaginal prolapse surgery using either general anesthesia or regional anesthesia. 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your vaginal prolapse surgery

The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warm.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.

  • A surgical team member will start an IV.

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • A team member will insert a catheter into your bladder to collect urine.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of vaginal prolapse surgery?  

As with all surgeries, vaginal prolapse surgery involves risks and possible complications. Most vaginal prolapse surgeries are successful, but complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

There has been some concern about the safety of mesh devices, also known as transvaginal mesh devices. Mesh is used in some, but not all, types of vaginal prolapse surgeries. Ask your doctor abo