Vaginal Prolapse Surgery
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.
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
Prolonged labor or having a large baby
Repeated childbirth or having a multiple birth, such as twins or triplets
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 about the specific type of device used and if a procedure that does not use a mesh device is an option for you.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, such as a deep vein thrombosis
Potential complications of vaginal prolapse surgery
Complications of vaginal prolapse surgery include:
Damage to nearby organs including the bladder or rectum
Return of symptoms including urinary incontinence, difficulty urinating, or vaginal prolapse and pain with intercourse
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Notifying your doctor immediately of any concerns, such as bleeding, bloody urine, fever, increase in pain, problems with urination, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my vaginal prolapse surgery?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for vaginal prolapse surgery by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
If you are overweight, talk to your doctor about losing weight before surgery through a healthy diet and exercise plan.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit or in an emergency situation. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need vaginal prolapse surgery? Are there any other options for treating my condition?
What type of vaginal prolapse procedure will I need? Does it involve a transvaginal mesh device?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
How long should I wait to have sex after surgery?
What assistance will I need at home?
How long will I need to have a urinary catheter after the surgery?
How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my vaginal prolapse surgery?
Knowing what to expect can help make your road to recovery after vaginal prolapse surgery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You will have a tube in your bladder called a catheter. This tube drains urine from your bladder until you have healed enough to urinate normally by yourself. Your catheter will stay in place from one to three days, depending on the type of vaginal prolapse surgery you had.
You will go home the same day for an outpatient vaginal prolapse surgery. Otherwise, you may stay in the hospital for up to four days, depending on the type of surgery and other factors. Your surgical and medical teams will monitor your healing during this time.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes a few weeks to a couple months.
Your doctor will give you specific instructions for rest during your recovery. Restrictions during recovery generally include avoiding strain of the lower abdomen for several weeks. This includes avoiding:
- Long periods of standing
- Sexual intercourse
- Straining with bowel movements
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after vaginal prolapse surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Change in alertness, such as passing out, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to have a bowel movement or pass gas
Problems with urination, such as not making urine
Unexpected drainage, pus, redness or swelling of your incision
How might vaginal prolapse surgery affect my everyday life?
Vaginal prolapse surgery is not 100% effective in all cases. It can relieve or greatly improve the symptoms of vaginal prolapse so you can lead a more active, healthy life. Life after vaginal prolapse surgery generally includes more freedom to perform many of your former everyday activities with fewer worries about incontinence and other symptoms.