Prolapse Surgeries, Part II
Prolapse Surgeries, Part II

Prolapse Surgeries, Part II

This article is a follow up to a Part I article I wrote on prolapse surgeries, where I covered a lot of FAQs about who needs surgery and why. In this article we'll cover the nitty gritty of surgeries, including the different types of surgeries and recovery times, etc.


By, Stephanie Dillon, PT, DPT, WCS

We won't rehash what I mentioned last time, so if you have questions about who might need surgery, and how successful surgery generally is or isn't, please revisit the past article!



What types of prolapse surgeries are there?


Basically, there are two types of surgeries. For most people who are members of MommaStrong and who are reading this article, they will have a type of surgery that preserves the ability to have vaginal intercourse. There is another type of surgery that basically closes off the vagina, but then of course after that you are no longer able to have intercourse. So that is typically reserved for elderly people with vaginas, as this type of surgery has the highest cure rate for prolapse. But of the types of surgeries that leave the vaginal canal open, there are many options depending upon the type of prolapse.



Does surgery vary based on the type of prolapse?


Yes! For bladder prolapse, the most common type of surgery is called an anterior colporrhaphy. In this procedure, the front wall of the vagina underneath the bladder has sutures placed in it to help reinforce the original position of the bladder.


For rectocele (rectal prolapse into the vagina), the most common type of surgery is a posterior colporrhaphy. This also involves placing sutures on the backside of the vaginal wall to help keep the rectum in place. Sometimes this is also done in combination with a repair of the perineal body (the area between the vagina and anus), aka perineorrhaphy.



What about uterine/cervical prolapse?


This gets a little tricky. Many times, if you are done having children and your prolapse is more advanced, you may be advised to have a hysterectomy. However, there are other options that will allow you to keep your uterus. These surgeries are a little more complicated to explain, but if you click this link, you'll find them explained well. Basically they all involve some method of re-suspending the uterus and the cervix by using either stitches or mesh (NOT the mesh that is involved in so many lawsuits!).


If you do opt to have a hysterectomy, then as you may imagine, this can place you at a higher risk of the bladder and/or bowel prolapsing (if they have not already done so). The uterus takes up a fair amount of space inside the pelvis, so if you remove it, that leaves empty space for other organs to fall into.



If I do have a hysterectomy, what are my options to avoid future issues with prolapse?


This is the one topic for which I will drag out my soapbox. If you do have a hysterectomy, and it is an option for you, I would HIGHLY recommend your surgeon re-suspends the vaginal vault as part of your surgery. The vaginal vault is the apex of the vagina, and where the vagina is sewn shut after the uterus/cervix are removed. Many surgeons will just stop here and allow the top of the vagina to essentially scar in place. However, as you can imagine, when you remove a major internal organ, then you are also removing (or slackening) a lot of ligaments & fascia that support that organ and others! So this places the top of the vagina at a much higher risk from prolapsing in the future, and/or the bladder and bowel falling into the vagina.


Please note, these "extra" steps to support the top of the vagina during a hysterectomy are not available to everyone. They do require more time under anesthesia, potentially greater skill from your surgeon, and that the structures the vaginal vault is being sutured to are still intact. For example, I had a friend that had severe endometriosis, and had a hysterectomy at 40 years old as a result. Her endometriosis was so advanced, and so many lesions had to be removed from inside the pelvis, that this didn't leave her surgeon with an option for a good place to suspend her vaginal vault. So even though I would recommend you discuss this with your surgeon, it's not an option for everyone.



What are the options for suspending the vaginal vault after hysterectomy?


There are many places from which the vaginal vault can be suspended after the uterus/cervix are removed.  There are too many to go into detail in this format, but all have their pluses and minuses. The main options are the uterosacral ligamentsacrospinous ligament, and the sacrum itself. More general information can be found in this handout.



What is recovery like after these types of surgeries?


Every surgeon is different, but here are some general guidelines for recovering from a hysterectomy or prolapse repair. And YES, many times there is more than one repair being done at a time! Or a hysterectomy may be combined with an anterior and/or posterior vaginal wall repair, for example.


Most often, you will have a catheter in place for anywhere from 8-24 hours after surgery (potentially longer for a bladder repair). And generally your hospital stay is very short.


Typically you need to take anywhere from 2-6 weeks off work. Around 2-3 weeks you can resume driving and taking short walks. And no sex (vaginal penetration) is allowed for 6 weeks.


It's also important to remember that because these are very delicate tissues, they are not fully healed for THREE MONTHS. So, for quite some time you will likely have restrictions on heavy lifting.


Have even more questions about your pelvic floor in general, or prolapse specifically? Here are two great websites for more info on all kinds of pelvic floor-related issues, not just prolapse:


International Urogynecological Association handouts


American Urogynecologic Society fact sheets

References:


All information contained in this post is aggregated from the handouts linked throughout the text.


Photo by Andrea Piacquadio: https://www.pexels.com/photo/photo-of-woman-lying-in-hospital-bed-3769151/