Vaginal prolapse is a medical condition that occurs when the pelvic floor muscles, ligaments, and tissues that support the pelvic organs become stretched and weakened due to age, pregnancy and vaginal childbirth, or lifestyle factors. This weakening causes one or more pelvic organs (i.e., the uterus, bladder, and rectum) to shift from their usual position and descend into the vaginal canal. In more advanced conditions, the pelvic organs can drop further and protrude out of the vaginal orifice.

Depending upon the severity of the condition, vaginal prolapse can be treated using self-care measures like pelvic organ exercises, lifestyle changes, pessaries, and various surgical approaches. Pelvic floor surgery is recommended for women who experience prolapse discomfort and have not found relief from non-surgical treatments. Pelvic floor surgery for vaginal prolapse can significantly reduce symptoms and improve your quality of life. However, all surgeries come with certain risks and side effects.

So, if you are thinking about considering vaginal prolapse surgery, this article is for you. It will discuss the different types of prolapse surgeries, how to prepare for them, and what to expect during and after the procedure.

Types of Vaginal Prolapse Surgery

There are several types of vaginal prolapse surgery, each designed to address specific types and degrees of pelvic organ prolapse. Other individual factors such as the woman's age, overall health, and desire for future pregnancies are also considered to determine the best surgical approach for each individual case. Some of the most common types of surgery for vaginal prolapse are:

Anterior vaginal repair

Also known as cystocele repair, anterior vaginal repair, is a surgical technique performed when the bladder drop from its usual position and push on the vaginal wall. During this surgery, the surgeon will move the bladder to its proper position then make an incision in the front vaginal wall. Sutures or mesh is then used between the vagina and bladder to support and reinforce it.

Posterior vaginal repair

Posterior vaginal repair is also known as rectocele repair. It is performed to correct prolapse of the bladder or the bowel into the back of the vagina. Your surgeon will make an incision in the back vaginal wall to position the rectum back in place and place a mesh or use sutures along the posterior vaginal wall to tighten and support it.

Total vaginal hysterectomy and prolapse repair

A total vaginal hysterectomy involves complete removal of the uterus and is typically done in advanced cases of vaginal prolapse. The surgeon will remove the uterus through the vaginal canal so no incisions on the abdomen would be made. A hysterectomy should be performed only after the woman is finished with having children. After this procedure, women are no longer able to get pregnant. A vaginal hysterectomy is done in combination with other prolapse repair surgeries for pelvic organ prolapse and urinary incontinence.

Sacrocolpopexy

This surgery can be done as an open abdominal surgery which is a more invasive procedure or laparoscopically meaning they make small incisions and cameras to access the inside of the abdomen which many surgeons do. Some even use robots to assist in this surgery. Sacrocolpopexy involves using a synthetic mesh or graft tissue to support the prolapsed organs and anchor them to the sacrum, the triangular bone at the base of the spine. This provides additional support to the pelvic organs and helps prevent prolapse.

Perineorrhaphy

Perineorrhaphy is performed to repair tears and lacerations of tissues and restore the anatomy and function of the perineum (the area between the vagina and anus). First scar tissues and excess skin at the perineum are cut then an incision is made to access the muscles underneath the skin. Sutures are then used to help reconnect those muscles for increased perineal support and tightening of the vaginal opening.

Colpocleisis

This surgical procedure involves closing the vagina to provide support to the prolapsed organs. This surgery is recommended for women who no longer desire vaginal intercourse.           

Preparation for Vaginal Prolapse Surgery

Before undergoing surgery, you might be asked to take a physical exam, blood tests, and other diagnostic tests to assess your health condition and identify any potential risks or complications.  

You may also be asked to stop taking certain medications or supplements before the surgery as they could increase their risk of bleeding or other complications during surgery. Typically, your doctor will ask you to avoid eating for 24 hours before surgery to avoid complications related to anesthesia. Depending on the procedure, you might also be asked to empty their bowels before surgery. If you smoke, you would be asked to quit smoking a few weeks before surgery.

Preparing for vaginal prolapse surgery can be overwhelming. You may experience anxiety or stress before the procedure. It may be helpful to talk to your physician or surgeon about any concerns or questions you may have about the procedure.

What Should You Know About the Procedure?

Learning about all the nitty-gritty of the procedure can help you understand what to expect during the surgery, and thus, help you cope better with anxiety and stress. 

Cost: The type of surgery, the surgeon's costs, and the location of the procedure are a few of the many variables that might affect the price of pelvic floor surgery for vaginal prolapse. The average cost of this procedure might run from a few thousand to tens of thousands of dollars. Depending on their insurance policy and the particulars of the procedure, women with insurance may be able to have some or all of the costs covered. Women without insurance might have to pay out-of-pocket for the surgery, which can be a considerable financial strain. It is important to speak with the surgeon and the hospital or surgical center about the costs associated with pelvic floor surgery and to explore options for financial assistance or payment plans if needed.

Anesthesia options: Typically, in most vaginal prolapse surgery, patients are administered general anesthesia. This means that you will be unconscious during the procedure. In some cases, your surgeon may prefer to give you local anesthesia, which numbs the lower half of your body but allows you to stay awake.

Surgical techniques: There are several surgical techniques used for pelvic floor surgery.

• Typically, surgeons make an incision in the vaginal wall to access and repair the pelvic floor connective tissues.
• Another approach is by making an incision in the abdomen to access the pelvic organs.
• Laparoscopic repair is a less-invasive procedure that involves making a small incision in the abdomen and using a laparoscope to access and repair the pelvic floor muscles.
• Robotic-assisted laparoscopic repair is another minimally invasive procedure that uses a robotic system to perform the surgery.

Duration of surgery: The duration of pelvic floor surgery depends on the technique of the surgery used and the complexity of the condition. Generally, the surgery can take anywhere from 1-4 hours.

Hospital stay and recovery time: After pelvic floor surgery, you may need to stay in the hospital for 1-3 days so that your doctors can observe how well you are recovering and intervene if any complication occurs. Recovery time depends on the extent of the surgery and the patient's overall health, but you can expect to resume normal activities within 4-6 weeks post-surgery.

Risks and Complications

Though rare, the procedure is not completely devoid of complications. Possible risks and complications of prolapse surgery include:

• Vaginal sores
• Bleeding
• Increased risk of urinary tract infections
• Pain and discomfort during sex
• Constipation or diarrhea
• Trouble urinating
• Damage to nearby organs
• Reoccurring symptoms, such as urinary incontinence
• Recurrence of prolapse
• Development of scar tissues

Follow-Up Care

Follow-up care after pelvic floor surgery is an important part of the recovery process.

You would be asked to schedule a follow-up appointment with your surgeon within 2-3 weeks after the surgery. During this appointment, your surgeon will check the incision site and discuss any concerns or complications.

In some cases, the surgeon may recommend you to do pelvic floor exercises at your home physically to help you regain strength and flexibility in the pelvic muscles. This may involve exercises to strengthen the pelvic floor muscles or other techniques to help improve bladder and bowel function.

You will also be prescribed medications to manage pain, prevent infection, or improve bladder or bowel function. For example, stool softeners may be prescribed after prolapse surgery. Heavy lifting, strenuous exercise or physical activities, and sexual intercourse should be avoided for a few weeks post-surgery. Your surgeon may also provide recommendations for other lifestyle modifications, diet changes, etc. It is important to follow the doctors directions and recommendations for a smooth and fast recovery post surgery. 

Pelvic floor surgery is a viable option for women who are experiencing pelvic organ prolapse and had no success with non-surgical treatments, such as pelvic floor exercises, pessaries, or medication. It can improve pelvic organ support, provide relief from prolapse symptoms like urinary incontinence, and improve the overall quality of life. However, as with any surgical procedure, there are certain risks to consider. If you are considering vaginal prolapse surgery, we encourage you to consult your healthcare provider about whether the procedure is right for you.

Medical Research on FemiCushion: Non-invasive Treatment Options for POP

FemiCushion is an alternative treatment option to pessary use and surgery for women who are suffering from pelvic organ prolapse. It does not require a doctors prescription and the user has complete control of the treatment. It features a supporter that is worn in place of underwear, a holder that absorbs excess discharge or urine, and a soft silicone cushion that is placed against the vaginal opening to support and prevent any prolapse from bulging out of the body. FemiCushion is discreet and offer women the comfort and support needed for every day life when diagnosed with POP. 

Journal of Obstetrics and Gynecology Research

In the investigation of severe pelvic organ prolapse (POP) featured in the Journal of Obstetrics and Gynecology Research, FemiCushion demonstrated the ability to effectively reposition prolapsed organs. Notably, the study indicated that FemiCushion achieved outcomes comparable to pessaries but without the associated risks. Magnetic resonance imaging revealed positive results in 12 participants, hinting at potential improvements in POP within just one month of FemiCushion use.

Pelviperineology Journal

A separate study conducted independently in São Paulo, Brazil, and published in the Pelviperineology Journal underscored FemiCushion's efficacy in women aged 60 to 79 over a three-month period. The research highlighted the device's reduced complication risks compared to pessaries. Significant enhancements were observed in symptoms like lower abdominal pain and pelvic bulges, positioning FemiCushion as a valuable option for enhancing the quality of life in individuals with POP.

Sexual Medicine Society of North America (SMSNA)

Presenting a study on dermal tissue transplantation for pelvic organ prolapse, the Sexual Medicine Society of North America (SMSNA) introduced a postoperative application of FemiCushion to support recovery and enhance patient quality of life. The external pessary exhibited benefits in managing sexual dysfunction, offering an alternative for those using a vaginal pessary. This study suggests that FemiCushion holds promise in postoperative care, providing additional support and improving overall outcomes.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.

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