Used to treat symptoms of pelvic relaxation and stress urinary incontinence. Many women have difficulty controlling their urine in certain situations or notice changes in their bowel habits. These two symptoms may be related to a common set of problems that may occur as a result of childbirth, aging or a combination of both. Grouped together these problems are referred to as pelvic relaxation. The pelvic organs include the vagina, uterus, bladder, and rectum. Some, or all, of these organs may be affected by pelvic relaxation. When the uterus drops out of its normal position, this is called uterine prolapse. Relaxation of the front wall of the vagina and/or bladder is a cystocele, and relaxation of the back wall of the vagina in front of the rectum is called a rectocele. Sometimes after a hysterectomy, the top of the vagina relaxes or “droops.” This is called vaginal vault prolapse. At times, a small amount of small bowel falls into this area (enterocele). The decision on how to treat pelvic relaxation depends on what part of the pelvis is affected.
The general symptoms associated with pelvic relaxation depend on which organs are affected. Often there is a feeling of heaviness or fullness. Woman often report pulling or aching feeling in the lower abdomen or pelvis. Difficulty urinating or having a bowel movement can occur. Small or moderate amounts of urine may be lost with normal physical activities such as laughing, coughing, walking, or running. In more advanced cases, a mass may actually protrude from the vaginal opening.
Treatment options include vaginal supportive pessaries, medication, and minimally invasive vaginal or abdominal surgeries to restore support of the vagina and pelvic organs. Treatment depends on the severity of symptoms. Surgery may be considered if symptoms are severe and disrupt one’s life, and if nonsurgical treatment options have not helped.
Reconstructive surgery reconstructs the pelvic floor with the goal of restoring the organs to their original position. Some types of reconstructive surgery are done through an incision in the vagina. Others are done through an incision in the abdomen or with laparoscopy, including robot-assisted surgery.
Types of reconstructive surgery
- Anterior and posterior colporrhaphy- With anterior colporrhaphy the anterior wall of the vagina is reinforced and strengthened with stitches so that it once again supports the bladder. During posterior coloporrhaphy, the posterior wall of the vagina is reinforced so that it once again supports the rectum. These procedures are performed through the vagina, so recovery time is shorter.
- Sacrocolpopexy- Through an abdominal incision, surgical mesh is attached to the vaginal vault and secured to the sacrum. This abdominal procedure may result in less pain during intercourse than procedures performed through the vagina.
- Surgery using vaginally placed mesh- Surgical mesh is placed through an incision in the vagina to help lift prolapsed organs into place or to reinforce repairs made to the vaginal walls. Mesh placed through the vagina has a risk of complications including mesh erosion, pain and infection. Because of these risks, vaginally placed mesh for pelvic organ prolapse usually is reserved for women in whom previous surgery has not worked, who have a medical condition that makes abdominal surgery risky, or whose own tissues are too weak to repair without mesh.
Recovery times vary depending on the type of surgery. For the first few weeks, you should avoid vigorous exercise, lifting, and straining. You also should avoid intercourse for several weeks after surgery until advised by your physician.