Vaginal Pelvic Floor Repair

What will be done?

This procedure will repair prolapse of the vagina and/or uterus using the vaginal approach, (from below). We will use Mesh (a strong weave of permanent suture material) or individual sutures to re-support the vagina and/or uterus to more solid structures in the pelvis. We can preserve the uterus or remove it (vaginal hysterectomy) at the same operation depending on the type of prolapse, any other problems and your age. Sometimes we may also perform an operation to repair urine leakage.

Why is this done?

Common reasons for performing prolapse surgery are; prolapse causing discomfort or pain, difficulty emptying your bladder or bowel, prolapse not reduced by pessaries, prolapse interfering with sexual activity.

What are the alternatives to this treatment?

A number of other conservative interventions may be appropriate for your particular condition and will normally have been considered prior to your surgery. These include pelvic floor exercises and vaginal pessaries. Pelvic Floor Repair may be performed vaginally, abdominally, laparoscopically or in a combination of the above, each with their specific advantages and risks. Vaginal Pelvic Floor Repair may reduce your recovery period (including hospital stay), reduce postoperative pain, and reduce the need for a general anaesthetic. It may be associated with complications, particularly vaginal shortening and scarring or erosion of mesh.

How is this done?

The procedure is normally performed under a general or spinal anaesthetic. A drip is inserted into your arm. A catheter (a tube for urine drainage) is inserted after you have been anaesthetised. If the uterus is to be removed an incision is made inside the vagina and the uterus and cervix are removed with or without both ovaries and tubes. Incisions are then made in the front and back walls of the vagina and the bladder and bowel that are prolapsing are supported with mesh or sutures. We sometimes remove excess vaginal skin, the cuts are then closed with sutures that will dissolve within six weeks. A pack of cotton is placed in the vagina to stop bleeding. We sometimes put a rubber splint in the vagina that will stay in place for a month. The procedure itself takes approximately one to two hours, but you can expect to be in theatre and recovery for a number of hours.

What should I do before the procedure?

Any investigations or consultations arranged at the preoperative consultation should have been completed. You should have only fluids (soups, jellies, juices or similar drinks) in the 24 hours prior to the surgery. The bowel preparation medication should be taken as ordered. You should continue your regular medications, unless advised otherwise. Stop smoking. Should you develop an illness prior to your surgery or have any questions, please contact our waiting rooms on 07 333 21 999

What should I do on the day of the procedure?

Unless otherwise specified, you should stop eating and drinking on the midnight before your operation.

You should continue all your usual medications, unless otherwise specified.

You should bring:

  • Toothbrush / paste / toiletries
  • Nightgown
  • Slippers
  • Underwear
  • Sanitary pads
  • All usual medications

What should I expect after the procedure?

When you wake from the anaesthetic, you will be in the recovery room. A drip will be maintained for one to two days and the catheter in your bladder will normally be removed the following day. You should expect a stay of one to two days in hospital. You will be given specific discharge medication if required, but you may use paracetamol as required (one to two tablets every four hours up to a maximum of eight tablets per day).

After discharge from hospital, you should:

  • Eat and drink normally
  • Remain mobile
  • Shower normally
  • Empty your bowels regularly

You should not:

  • Have intercourse for 6,weeks
  • Undertake any heavy lifting or straining for 6 weeks.

You should expect some vaginal discharge for several days after the procedure. It is normal to experience some depression after this procedure. You should visit the nurse at your GP to have the sutures removed from your abdominal wounds seven days after the operation. You may require up to six weeks off work. You should have returned to normal activity by three months, but full recovery may take longer. Pelvic Floor Repair may result in variable bladder and bowel dysfunction.

Once the vaginal prolapse has been corrected you may develop leakage of urine. This resolves in most women after six months, others may require an operation to correct the leakage. You may have difficulty in emptying your bowel, it is important not to gel constipated or strain on the toilet. A balanced diet with fruit and fibre will reduce this happening. Any prolapse surgery can change how your vagina functions with sexual activity, you may experience reduced sensation or pain, this usually resolves.

What are the complications of this procedure?

Every surgical procedure has associated risks. Complications include, but are not limited to:

  1. The anaesthetic
  2. The surgery – injuries to bladder, ureters (connection between the bladder and the kidney), bowel or blood vessels, requiring further surgery, blood transfusion or longer admission; the procedure may not be able to be completed laparoscopically, and you may require an “open” operation with an increased hospital stay
  3. The recovery period – infections of the bladder, wound (internal and external), abdomen or lungs; blood clots that may form in the leg or pelvis and travel to the lung; unpredictable wound healing; variable postoperative pain and recovery
  4. Difficulty passing urine – There is a small risk that you may have difficulty passing urine after the operation. You may need to go home with a catheter in your bladder or passing a small catheter to empty your bladder intermittently. This usually settles within one to two weeks.
  5. Mesh Erosion – There is a small risk of mesh eroding through the vagina. The risk is small when placed laparoscopically compared to placing it vaginally.
  6. Recurrence of Prolapse – With any prolapse surgery there is a risk of the prolapse returning after surgery. The risk of recurrence is smaller with laparoscopic and abdominal surgery compared to most vaginal surgery.

What if I have any problems?

You should notify your GP, or the office if you experience the followingproblems:

  • Fever or feeling unwell
  • Smelly vaginal discharge or heavy bleeding
  • Wound becomes hot, painful or discharges
  • Constant nausea or vomiting
  • Severe pain

Inability to empty your bladder or bowels

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