Vaginal prolapse is a common condition where the bladder, uterus and or bowel protrudes into the vagina. This can cause symptoms such as a sensation of a vaginal lump, constipation, difficulty emptying the bowel or bladder or problems with sexual intercourse. Treatment is only indicated when the prolapse is symptomatic. The majority of women will have improvement of symptoms following an operation.
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Treatment options
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Vaginal pessary
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Some women will be suitable to try a vaginal pessary instead of surgery. Vaginal pessaries are a device, which supports the vagina, which need to be changed every 3 to 6 months. Vaginal pessaries have been proven to be successful as surgery in relieving prolapse symptoms in these women.
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See: Vaginal pessary for prolapse fact sheet.
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Surgery
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Depending on the severity of your symptoms and the type of prolapse your doctor may suggest you have surgery. The aim of surgery is to provide support for your vagina or uterus. Previous experience has shown that about 70% women undergoing conventional vaginal prolapse surgery have a successful outcome. Mesh reinforcement is used with the aim of reducing the risk of recurrence of the prolapse. It may provide a longer lasting repair and has been shown to be successful in 80% of people. The use of surgical mesh to reinforce prolapse repair is not new.
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What is mesh?
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- Mesh is a synthetic material and is permanent.
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- Mesh has been extensively used in surgery, especially in hernia repairs.
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- The mesh has many holes within it to allow the body's own tissue to grow into the mesh. The mesh then provides a framework of support.
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What happens during surgery?
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- Women undergoing a vaginal prolapse surgery can have the operation with regional (spinal) anaesthetic or general anaesthetic.
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- There will be incisions made inside the vagina and the tissue supporting the vagina will be strengthened with stitches. This may be at the front or the back walls of the vagina or both, depending on the type of prolapse you have.
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- The mesh is then placed underneath the vaginal skin. The body's own tissues will grow into the mesh within 3-4 weeks. The mesh provides reinforcement of the weakened vaginal tissue.
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- The incision inside the vagina is then closed with stitches that will dissolve in one to two weeks.
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- An additional stitch (sacrospinous stitch) may be required at the top of the vagina or into the cervix to support the vagina. This stitch may cause some discomfort in the buttock which may persist for up to three months.
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- At the end of the operation a catheter will be inserted into the bladder to drain urine and a material pack will be placed in the vagina to prevent bleeding. These will remain in place for one to two days.
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- Antibiotics will be given during the surgery, and you will be asked to take antibiotic tablets for one week after the surgery.
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- If you still have your womb (uterus), your doctor may suggest that you need a hysterectomy at the same time of your prolapse repair. Some reasons for recommending a hysterectomy include:
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 | - prolapse of the uterus itself
- period problems.
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Vaginal support device
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- For some women having their prolapse repaired with mesh reinforcement, your doctor may recommend placing a vaginal support device (VSD) into the vaginal at the completion of surgery.
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- The use of a vaginal support device (VSD), along with the mesh, is a new approach to surgery.
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- The purpose of the VSD, which remains in the vagina for four weeks following surgery, is to provide extra support for the vagina during the healing period. The VSD also simplifies surgery when mesh is used and this may have additional benefits such as shorter operating time and less complications from surgery.
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- The VSD is made of a soft comfortable material, which is well tolerated by most patients.
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- The VSD is easily removed by a doctor or nurse in the outpatients department during the post-operative check-up 4 weeks following surgery. Removal of the VSD is usually not uncomfortable.
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- The VSD may cause a discharge from the vagina approximately 2 weeks after surgery. This discharge will disappear after the VSD is removed.
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- The VSD may move down slightly after 3 weeks. If you feel the VSD has moved down you may gently push it up to a more comfortable position.
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- If the VSD is causing significant discomfort or concern you should contact your doctor.
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Are there any complications?
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- Possible complications and discomforts from vaginal surgery for prolapse include pain, infection, perforation of the rectum or bladder, recurrence of symptoms and/or prolapse, and pain with intercourse.
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- Whenever mesh is used, there is a small risk (about six percent or six in one hundred) of a tiny potion of the mesh becoming exposed in the vagina. This is usually treated with oestrogen if the vaginal skin is thin or a small vaginal operation to cover the mesh.
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- There may be a slightly higher risk of infection with the use of mesh and all women will be given antibiotics during the operation.
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- There are risks with having an operation, including the risks associated with anaesthetic; there is a risk of bleeding and the possibility of needing a blood transfusion. You are also at risk of infection within the pelvis or wound as well as clots in the legs that can travel to the lungs.
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See also the fact sheets:
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Informed consent
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The informaiton in this fact sheet contains detialed informaiton about your surgery. Its purpose is to explain to you as clearly as possible the procedures and risks involved before you decide whether or not to proceed. Please read the information carefully. Feel free to ask questions. You may also wish to discuss the surgery with a relative or friend or your local health worker. We encourage you to do do this.
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Once you understand what is involved and you agree to proceed, you will be asked to sign a consent form. By signing the form, you are indicating that you understand the information and that you give your consent.
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We will give you a copy of the patient informaiton to keep as a record.
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Your surgeon will also be happy to answer any questions that you have.
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If you experience complications after you leave hosptial, contact your doctor or attend your closest emergency depatment.
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Where to get more information
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Urogynaecology Pelvic Floor Service
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The Royal Women's Hospital
Locked Bag 300
Grattan St & Flemington Rd
Parkville VIC 3052
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Tel: (03) 8345 2000
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Disclaimer
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The Royal Women’s Hospital does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided in this fact sheet or incorporated into it by reference.
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We provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy.
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Women are encouraged to discuss their health needs with a health practitioner.
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If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.
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Last reviewed: Jan 2008
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