Prolapse

Vaginal Prolapse

A prolapse is a condition where an organ or tissue falls down or slips from its normal position. Vaginal prolapse is a condition where the pelvic organs such as bladder, rectum, uterus, urethra, and small bowel protrude into the vaginal wall. Several types of vaginal prolapse conditions have been identified and they include:

• Cystocele – Bladder protrudes into the vagina
• Rectocele – Rectum protrudes into the vagina
• Vaginal vault prolapse – Top portion of vagina herniates into vaginal canal
• Uterine prolapse – Uterus prolapse into the vagina
• Enterocele – Small bowel herniates into vagina

The main cause of vaginal prolapse is the weak muscles, tissues, and ligaments that support the vagina, surrounding tissues and organs. The factors that can cause vaginal prolapse include frequent lifting of heavy objects, chronic cough, severe constipation, menopause, childbirth, previous surgeries in the pelvic area, advanced age, hysterectomy and obesity.

Women with prolapse may have different symptoms based on the type of prolapse. The signs and symptoms include difficulty in urinating and emptying bowel, enlarged and wide vaginal opening, vaginal lump, and the protrusion of tissues at the front and back wall of the vaginal.

Surgery is done to restore vagina and the pelvic organs back to their respective positions and provide symptomatic relief. It helps to strengthen the muscles around the vagina and prevent further damage of pelvic floor muscles. Vaginal prolapse surgery may be done through laparoscopy or open surgery. Various surgical procedures are performed to correct the prolapse of different pelvic floor organs.

• Colporrhaphy – Colporrhaphy is the surgical procedure to correct cystocele and rectocele. In this procedure, your surgeon makes an incision in the vaginal wall. The bladder and rectum are pushed back to their normal positions, the excess tissue is removed and the incisions are closed. If you are suffering from urinary incontinence (involuntary leakage of urine) then your surgeon may use a splint to support the urethra and this procedure is called as bladder neck suspension.
• Uterine suspension – This procedure is done to correct uterine prolapse using laparoscopic technique, where the uterus is pushed to its normal position. Incisions are made on the vaginal wall and the vagina is attached to a strong ligament at the back of pelvis or at the base of the spine to support the vagina. Uterine prolapse can also be treated by a procedure called as hysterectomy where the uterus is removed. After hysterectomy you will not be able to have children.
• Surgery for enterocele – Enterocele may be developed in women who have had a rectocele and/or hysterectomy. In women who had hysterectomy, the supporting structures or the ligaments of the anterior and posterior vaginal walls may not be fused together into the uterus. This creates an area that lacks support which further causes the muscles and the ligaments to bulge out into the vagina.
  In the enterocele repair, the ligament and muscles are reattached to the top of the vagina with the help of sutures. Suturing the vaginal walls will only repair the defect and will not provide support to the apex of vagina to the supporting structures. Often, following the enterocele repair other procedures may be performed to correct the abnormalities that are found together with enterocele. Other surgeries done with enterocele are for cystocele, rectocele and vaginal vault prolapse.
• Sacrohysteropexy – It is another method to correct uterine prolapse. This procedure can be done through open surgery or laparoscopy. A synthetic mesh is used where one end of the mesh is attached to the cervix and top of the vagina and the other end is attached to the sacrum, at the base of the spine. The mesh provides support to the weakened vaginal wall.
  Meshes are available in various sizes and shapes. It reduces the risk of recurrence of prolapse and enables the growth of new tissue through which this tissue incorporates the mesh into surrounding area.
• Vaginal vault suspension – It is the similar to uterine suspension procedure. The top of the vagina is attached to a strong ligament at the back of the pelvis or at the base of the spine to support the vagina.
  Other surgical procedures to correct vaginal vault prolapse include
  • Sacral colpopexy – In this procedure, one end of the mesh is attached to the top of the vagina and the other end is attached to the upper part of sacrum situated at the base of the spine. This mesh helps to repair the damage in the tissue.
  • Plication – In this procedure, the weakened tissue is re-attached to the other tissues.

Every surgical procedure may be associated with certain risks and complications. The possible complications after the surgeries for vaginal prolapse include pain, infection, bleeding, recurrence of symptoms, injury to ureters, and perforation of rectum and bladder. The complications are usually mild and can be treated accordingly.

The advantages of choosing minimally invasive surgery is that the defects can be clearly identified, incisions are small, post-operative pain and discomfort is reduced, shorter duration in hospital, and less time for recovery.