This information sheet describes some of the options for the surgical treatment of prolapse. If prolapse is causing medical problems or symptoms that bother you, it may be necessary to consider surgery. Your doctor will discuss surgery with you fully before you decide to go ahead. Other possible treatments include pessaries placed inside the vagina, or simply leaving things alone if things aren’t too bad.
Prolapse surgery often involves a vaginal repair operation. Sometimes this also includes a vaginal hysterectomy (removal of the womb through the vagina). These operations are usually done through the vagina, all the stitches are inside the vagina and there is no scar on your tummy.
There are different sorts of repair operations but usually a ‘tuck’ is made in the wall of the vagina and sometimes the supporting fibres or ligaments are tightened up. The stitches used are usually dissolvable one’s and therefore don’t need to be removed after your operation. Sometimes the doctor will use a mesh or tissue to help support your vagina. This is more commonly used if your prolapse comes back after previous surgery.
Sometimes to hold the vagina up more strongly, a stitch or two is put in deeper inside you. This stitch goes in to a strong ligament in the pelvis, (the sacrospinous ligament). This part of the operation aims to prevent your prolapse coming back and also helps to keep the normal length of your vagina if you are sexually active. There is a risk with this extra fixation stitch that damage can occur to blood vessels, bowel, urinary system or nerves. The stitch also makes the operating time longer.
If the prolapse is complicated or has come back after surgery, it may be necessary to perform an operation through a cut in your tummy. The sacrocolpopexy, fixes your vagina to the bone at the back of your pelvis (the sacrum) to give stronger support. Material or mesh is often used and this helps to hold things in place. There is a small risk that this material can cut through into the vagina or get infected. Because the bowel and urinary systems are close by, there is a risk that they could be damaged in this operation. A further operation may then be needed to sort such problems out. Because the sacrocolpopexy is performed through a cut in your tummy, the operation usually takes longer to carry out and longer to recover from than surgery done through the vagina.
Prolapse surgery may be carried out under a spinal anaesthetic so that you can be awake during the operation, but without pain or sensation below, or under a general anaesthetic (whilst you are asleep). The anaesthetist will discuss the anaesthetic before the operation. If you have any other medical problems, then these may require special attention before surgery.
Sometimes the operation you have for prolapse will change from the original plan, either because of what the doctor finds or difficulties during the operation. In this case your doctor will do what he or she thinks is best for you at that time. This sometimes involves more extensive surgery than originally planned, sometimes less.
About a third of women who have prolapse surgery need more than one operation because the prolapse comes back or a different type of prolapse develops. For example, a prolapse of the womb can occur after an operation for prolapse of the vagina and vice versa.
Prolapse surgery usually improves or cures the symptom of ‘something coming down below’ or the lump in the vagina. Symptoms relating to the bowel or bladder such as constipation or incontinence are often not improved. Similarly problems with your sex life may not be improved with surgery.
If a mesh or extra tissue is used in a prolapse operation, there is a chance that this can get infected or cut through (erode). This may require a further operation to remove part of the mesh or repair any damage.
Occasionally, some new bowel or bladder symptoms occur after prolapse surgery, which may require further treatment in the future, including further surgery. Some women develop incontinence after prolapse surgery and some have problems emptying their bladder and need to use a catheter afterwards. This problem usually gets better with time.
There is a small risk of venous thrombosis (clots forming in your legs and lungs) with any pelvic surgery. To reduce this risk you will be given an injection every day and some anti-embolic stockings to wear.
You will be in hospital for 2 - 6 days depending on the type of operation you have and your general health and fitness. After this you will usually need to recover for 6 weeks, and must avoid heavy lifting and strenuous exercise for three months. You will be given further information with a booklet explaining what to expect following discharge home from hospital.