What is vaginal prolapse?
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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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For some women it will be suitable to try a vaginal pessary instead of surgery. Vaginal pessaries are a device which supports the vagina and need to be changed every 3 to 6 months. Vaginal pessaries have been proven to be as successful as surgery in relieving prolapse symptoms in these women.
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See also: fact sheet Vaginal pessary for prolapse.
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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.
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What happens during surgery?
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- Women undergoing 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 incision inside the vagina is then closed with stitches that will dissolve in 1-2 weeks.
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- An additional stitch (sacrospinous fixation stitch) may be required at the top of the vagina or into the cervix to support the vagina. This stitch may cause some temporary discomfort in the buttock which may persist for up to three months.
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- In some women, mesh may be used to reinforce the prolapse repair.
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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. They will be easily removed by a nurse in the ward.
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- Antibiotics will be given during the surgery and, if mesh was used in the operation, the antibiotics may be continued for one week.
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- If you still have your womb (uterus), your doctor may suggest that you need a hysterectomy at the same time as your prolapse repair. Some reasons for recommending this include:
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 | - prolapse of the uterus itself
- period problems
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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, injury to the ureters, recurrence of symptoms such as urinary incontinence or difficulty voiding and/or prolapse and pain with intercourse.
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- There are general risks involved with having an operation, including the risks involved with having an anaesthetic, bleeding and the possible need for a blood transfusion, infection within the pelvis or wound and there is a risk of clots in the legs that can travel to the lungs.
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Recovery time and instructions following surgery
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Most women stay in hospital for three to five days. You can go home once you are feeling well and once you are able to pass urine with no problem.
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It is important to rest after the operation and allow the area to heal.
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For the first two weeks:
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- vaginal loss will be minimal and light pink for up to two weeks.
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For the first two to four weeks:
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- keep your activity light and easy
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- avoid heavy lifting (nothing heavier than four kilograms), including shopping bags, washing baskets and children.
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- avoid playing sport, swimming and impact exercises such as jogging or jumping for four weeks
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- you may have a sudden, moderate vaginal loss in the first eight to ten days, which should then stop
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- any stitches that you still have in when you go home will fall out once they dissolve in about ten days (and up to three weeks). These do not need to be removed.
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For the first six weeks:
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- abstain from sexual intercourse.
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You may:
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- drive a car after two weeks; however, check this with your car insurance provider.
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Pain relief
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- We suggest that you take paracetamol (such as Panadol) every four hours for two weeks (medications with codeine, like Panadeine, are constipating).
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- Ensure you take some time each day to rest.
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Maintain good bowel habits
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- Try to drink approximately 1.5 litres of fluid each day.
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- Use Metamucil or a similar preparation (available at chemists) if required to promote a soft, easy stool.
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Informed consent
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This Patient Information contains detailed information about the surgery. Its purpose is to explain to you as openly and clearly as possible the procedures and risks involved before you decide whether or not to proceed.
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Please read this Patient Information carefully. Feel free to ask questions about any information in the document. You may also wish to discuss the surgery with a relative or friend or your local health worker. Feel free to do this.
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Once you understand the surgical procedure and risks and if you agree to proceed, you will be asked to sign the Consent Form. By signing the Consent Form, you indicate that you understand the information and that you give your consent.
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You will be given a copy of the Patient Information to keep as a record.
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Your surgeon will be happy to answer any questions you have, and can give more specific advice.
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If you experience complications after you leave hospital, contact your local doctor or attend your closest hospital emergency department.
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Further information
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Royal Women's Hospital
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Urogynaecology Pelvic Floor Service
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Locked Bag 300
Grattan St & Flemington Rd, Parkville VIC 3052
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Tel: (03) 8345 2000
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Related fact sheets
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Vaginal pessary for prolapse
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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.
We provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. 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 updated Jan 2008
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