What is pelvic organ prolapse?

 

Pelvic organ prolapse is when your pelvic organs like your bladder, uterus or rectum drop out of their normal places. It can create a bulge in your vagina and sometimes push out of your vagina.

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When the front part of your vagina bulges, this is your bladder falling down. This is called cystocele.

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When the back part of your vagina bulges, this is your rectum falling down. This is called rectocele.

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When the uterus falls down, this is called uterine prolapse.

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If you have had a hysterectomy your uterus has been removed by surgery, and the top of the vagina is falling down, this is called vaginal vault prolapse.

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If you have prolapse, you will most likely have a combination of all these different types of prolapse.

 

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How do I know if I have pelvic organ prolapse?

 

If you have prolapse, you might notice:

• A bulge at the vagina opening

• Feeling fullness or heaviness in your pelvic region

• Problems with urination or having a bowel movement

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I have a pelvic organ prolapse. Do I need treatment?

 

If you do not have any problems or your symptoms are mild, you do not need any special follow up or treatment besides your regular checkups.

 

If you have symptoms, prolapse can be treated with or without surgery.

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What should I think about when deciding if I should have surgery?

• If you want children: pregnancy can make prolapse come back if you have surgery. You should wait until you have decided to not have any more children.

• Health conditions: any surgery has risks. Some health conditions like heart problems or previous stroke might put you at higher risk of problems from surgery.

Your surgeon will discuss surgery details, success rates, risks and complications, and potential life style changes with you.

 

 

I would like surgery. What procedures can be done?

 

Vaginal Hysterectomy

This is the removal of your uterus or womb 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 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.

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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 be given a prescription for pain medication.

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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.

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I don’t want surgery but my prolapse bothers me. Is there anything I can do?

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Pessaries

A pessary is a silicone rubber or plastic device that you can put into the vagina to support the uterus, bladder and rectum so that they don’t fall down.

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There are many types and shapes.

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The most common one looks like a rubber ring. Your doctor (or our urogynecology nurse) will help you find one that is the right fit for you. If the pessary is properly tted for you, you will not notice it when it is in place.

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When you have a pessary, it is normal to need a change in the shape or size of the pessary over time.

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You might notice more discharge with the pessary. A pessary needs to be cleaned. Your doctor or the urogynecology nurse will show you how to take out the pessary, clean it and put it back in. If you have a pessary, you should see your doctor if:

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• You are uncomfortable

• You notice any vaginal bleeding

• You notice bad smelling vaginal discharge

 

 

 

 

 

 

 

 

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Pelvic Floor Physiotherapy

A physiotherapist that specializes in the muscles of the pelvis can help you exercise and strengthen those muscles and ligaments. They also have other techniques to stimulate the nerves and muscles. Physiotherapy may help decrease the symptoms caused by the bulge from your prolapse. Ask your doctor for a referral to a pelvic oor physiotherapist.

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Sunnybrook Health Sciences Centre

2075 Bayview Avenue Toronto, ON M4N 3M5

Telephone: 416.480.6100

www.sunnybrook.ca
PR 47193 (MAR 2016)