PELVIC FLOOR RECONSTRUCTION
What is pelvic floor reconstruction?
The pelvic floor is composed of muscles, ligaments, connective tissue and nerves that support the pelvic organs (rectum, bladder, uterus, and vagina). Pelvic floor reconstruction aims to repair these support structures when they become weak. When the pelvic floor is weak, you might experience pelvic organ prolapse or stress urinary incontinence.
SURGICAL TREATMENTS FOR PELVIC ORGAN PROLAPSE
Vaginal Hysterectomy
This is the removal of your uterus or womb (hysterectomy) by making an incision in your vagina. There are no incisions on your abdomen. When you have this surgery, your cervix is also removed. Your ovaries do not have to be removed at the same time. When a vaginal hysterectomy is done for prolapse, other surgeries are usually also done to fix the prolapse from the front and the back of the vagina. These are called anterior and posterior vaginal repairs.
Anterior Vaginal Repair
This is done when the front part of the vagina is bulging from the bladder pushing against it. The skin inside the vagina is cut and the bladder is separated from the vagina. Stitches are placed to push the bladder back up. Sometimes a dissolvable mesh can be placed to help create scar tissue to hold the bladder in place. The extra vaginal skin is then trimmed o and the vagina is stitched back together.
Posterior Vaginal Repair
This is done when the back part of the vagina is bulging from the rectum pushing against it. The skin inside the back of the vagina is cut and the rectum is separated from the vagina. Stitches and sometimes a dissolvable mesh is placed to push the rectum back in and create scar tissue to prevent it from coming back.
Laparoscopic Vault Suspension (or Sacrocolpopexy)
This is a keyhole surgery (laparoscopy) where 4 small incisions are made on the abdomen. In one of these holes, a thin telescope with a light is inserted to help your surgeon see. Long instruments are put in the other holes to let your surgeon do the surgery. A small probe is used to push the vagina inside. A piece of permanent mesh is stitched from the top-back wall of the vagina using permanent stiches and attached to a strong ligament in front of the tailbone using special titanium staples.
SURGICAL TREATMENTS FOR STRESS URINARY INCONTINENCE
Transobturator Tape
This is a very common procedure performed for women with stress urinary incontinence. Your doctor will use a synthetic material (called polypropylene mesh) to create a sling or a hammock for your urethra to rest on. This supports the urethra as the bladder becomes full. The surgery is done vaginally – there are no cuts on the abdomen.
Laparoscopic Burch Urethropexy
This procedure is done by using 4 small cuts on the abdomen and putting a telescope through one of these cuts to let your surgeon see inside your abdomen. Using stitches, the tissue beside the urethra and the vagina is lifted up to a ligament beside the pelvic bones. By lifting these tissues, the urethra is better supported.
Laparoscopic Two-Team Sling
This procedure requires two surgeons, one that works up at the abdomen and the other works in the vagina.4 small cuts are made on the abdomen. Each end of a synthetic material is inserted either side of urethra from the vagina by the vaginal surgeon and is retrieved abdominally by the abdominal surgeon. The mesh is then stitched to ligaments beside the pelvic bones. This creates a hammock for your urethra to rest on. It can also help to repair any prolapse (or bulge) of the bladder into the vagina.
GENERAL RECOVERY INFORMATION
How long will it take me to recover?
After you wake up from the general anesthetic, you will feel sleepy. Some women might feel sick and vomit. You will need someone to drive you home. Most women will stay 1 night in the hospital. A gauze (called vaginal packing) will be placed in your vagina overnight to help reduce bleeding. This will also be taken out in the morning.
A rubber tube, called a foley catheter, is placed into the bladder at the beginning of the surgery and removed the next day. Sometimes women have trouble urinating after this surgery. If this happens you might need to go home with the catheter and a nurse will come to your home in 4 to 7 days to take it out and to see if you can urinate. You will be given a prescription for antibiotics to prevent a bladder infection. Everyone will urinate again on their own after surgery but it may take time.
You will also be given a prescription for pain medication.
Recovery will take about 4 to 6 weeks.
How do I take care of my surgical wounds?
If you have a lot of swelling, you can use ice packs to help. Do not apply the ice packs directly to the skin. Use a towel to wrap around the ice pack. Starting 1 week after your surgery, you can start sitz baths. This is where you soak only your bottom in cool water. You can buy a bath at the pharmacy. The bath can be attached to your toilet to make it easier to soak your bottom.
You will also be given a prescription for a vaginal cream. Starting 1 week after surgery, you will need to insert this cream into the vagina 2 times per week (for example, on Mondays and Thursdays).
It is very important to avoid sex, exercise, heavy lifting over 10 lbs and constipation for 6 to 8 weeks. Stool softeners and laxatives can help.
Who will be involved in my surgery?
On the day of surgery, you will meet the surgical team. This will include:
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Your doctor
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Surgical assistants: these are usually trainees supervised by your doctor. They can include:
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Fellows (doctors who are licensed obstetricians and gynecologists and are doing extra training to perform minimally invasive surgery)
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Residents (doctors are training to become obstetricians and gynecologists)
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Medical students (these are students learning to become doctors)
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Nurses
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Anesthesiologist (doctors who put you to sleep during surgery)
When should I be concerned?
While it is normal to have some pain and bleeding after surgery, you should see your doctor or go to the emergency room immediately if you have the following:
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Abdominal pain that is getting worse
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Heavy vaginal bleeding (changing 2 to 4 pads over 2 hours)
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Fever
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Chest pain or difficulty breathing
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Severe pain, swelling and redness in on or both legs
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Unable to urinate
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Severe nausea (feeling sick to the stomach) and vomiting
Who do I contact if I have questions?
If you have any questions or concerns, please call your gynecologist’s office.
Sunnybrook Health Sciences Centre
2075 Bayview Avenue Toronto, ON M4N 3M5
Telephone: 416.480.6100
