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Prolapse & Vaginal Repair

A genital prolapse is caused when there is damage or weakness to the supporting sling or ligaments which hold the uterus and other pelvic organs. Weakness to these tissues can be a result of childbirth, chronic coughing or straining. Prolapse frequently occurs around the time of menopause as oestrogen levels fall and cause the pelvic floor muscles and tissues to weaken.

The uterus may descend in varying positions, pressing on the bladder or rectum. There are three main types of genital prolapse:

  • Cystocele (or anterior prolapse)- The bladder protrudes into the anterior wall of the vagina

  • Rectocele (or posterior prolapse)- The rectum protrudes into the posterior wall of the vagina

  • Enterocele- The Pouch of Douglas (area between uterus and rectum) protrudes into the vagina

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Symptoms of Prolapse

  • Dragging feeling down below

  • Backache

  • Urinary frequency and infection – associated with cystocele

  • Constipation – associated with rectocele

  • Painful Intercourse

What is a Vaginal Repair?

A vaginal repair operation is performed to correct a genital prolapse. It can be performed with a hysterectomy, or the uterus can be left intact, with just the prolapse being corrected.

The vaginal repair aims to tighten, strengthen and lift the weakened tissues in order for the uterus and/or the bladder and rectum to return to their original positions and the associated symptoms to diminish. The operation is performed vaginally and dissolvable sutures are used.

Anterior Repair

An anterior repair is performed when a woman has a cystocele. An incision is made into the anterior wall of the vagina. 1-2 sutures are placed deep around the bladder neck and excess vaginal skin is excised. This operation results in the bladder neck being elevated and supported.

Posterior Repair

A posterior repair is performed when a woman has a rectocele. An incision is made into the posterior wall of the vagina, and the tissue between the rectum and vagina is tightened. Any excess skin is excised; the levata ani (pelvic floor muscles) and perineum are then sutured together over the incision. The operation results in the rectum being elevated and supported.

Following a posterior repair, it may be painful when you attempt to open your bowels. You may be commenced on laxatives to help ease the discomfort. If you do experience pain, a local anaesthetic gel can be applied to the area, as well as ice packs to help reduce the swelling.

The average stay in hospital is 3-5 days.

You will generally be feeling back to normal in six weeks, although everyone heals at different rates. It is important to drink one to two litres of fluids every day to prevent urine infections, and eat a balanced diet to prevent constipation. You should not lift anything heavy or do any intensive exercise for at least six weeks. Gentle walking is fine. You should abstain from sexual intercourse during the six weeks recovery, and you may also notice a vaginal discharge during this time.