Pelvic floor muscles, ligaments and tissue support and control your bladder, uterus, vagina and rectum. If these muscles weaken, your pelvic organs can prolapse.
Prolapse can cause urinary leakage, pain and pressure during sex. These problems may improve with physical therapy.
If these treatments don’t help, your doctor at Women’s Specialists of Plano and Frisco, Texas may recommend pelvic floor repair surgery.
Uterosacral Ligament Suspension
Uterosacral ligament suspension surgery is a form of native tissue repair. It involves stitching the top portion of your vagina to your uterosacral ligaments. This helps correct pelvic organ prolapse, which are collapsed tissues in the lower abdomen and can cause pain and pressure.
Your urogynecologist performs this procedure through the vagina or by laparoscopy. It’s a minimally invasive surgical technique, and your urogynecologist will choose the best method for you.
After identifying vital structures, your urogynecologist creates two laparoscopic sacral incisions. A long Allis suture is used to grab the right posterior vaginal cuff, which is then suspended using delayed absorbable sutures and anchored with 0-polydioxanone. The same is done to the left side.
This procedure reduces the likelihood of ureteral kinking or obstruction, and it prevents your uterus from moving up toward your vaginal canal. It also helps to strengthen your pelvic floor muscles and reduces urinary incontinence, fecal incontinence and pelvic pain.
Studies suggest that laparoscopic uterosacral ligament suspension is an effective and safe treatment for apical pelvic organ prolapse. The results show that this method improves Pelvic Floor Impact Questionnaire14 scores, bladder strength and quality of life in post-menopausal women with apical prolapse. However, further prospective and randomised controlled trials with longer follow-up are needed to validate the effectiveness and safety of this approach to treating apical prolapse.
Posterior Vaginal Prolapse
When a prolapse develops in the posterior (back) vaginal wall it may cause symptoms such as discomfort when having sex or difficulty keeping a tampon in. This is caused by weakening of the support tissues between the bladder and bowel, which causes the bowel to protrude through the posterior vaginal wall. It is not life threatening and some people do not require treatment for this condition.
The doctor repairs this by centrally plicating the fascia, anchoring it through the obturator foramen and exiting through small incisions on both sides of your upper inner thigh. A permanent mesh reinforces the repair.
You may experience a blood-stained discharge from the incision site for about a week after surgery, this is normal and will gradually decrease. You may also notice the surface knots of your stitches appearing on your underwear, again this is quite normal and will gradually disappear over a few weeks.
The success rate of a posterior pelvic floor prolapse repair is 85%-90%. Like all surgical procedures complications do occur; 5-15% women will experience recurrent prolapse, 5% experience a mesh erosion/infection, 1-5% may have urinary leakage that was not present before the operation and 5% will have difficulty passing urine necessitating prolonged self-catheterisation. This is an important operation and we encourage patients to seek specialist advice when considering it.
The sacrospinous ligament is a strong fibrous structure that supports the cervix and upper vagina. When this ligament is damaged, the cervix and upper vagina may prolapse downward toward the greater sciatic foramen. This is a common problem in women who have had hysterectomy, particularly those with previous large multiple births.1
The goal of this surgery is to repair this prolapse using the sacrospinous ligament. It is important to do this as quickly and carefully as possible so that the womb can return to its normal position in the pelvis.
Several suturing and anchoring devices have been developed to facilitate this procedure. However, their use can be complicated by the proximity of the sacrospinous ligament to nerves and vessels (especially the pudendal nerve, internal pudendal artery, and vein) that can be injured.
Your consultant will discuss your options with you and advise on the best treatment for your situation. They will take into account your age, your medical history and whether you have any other underlying health problems or conditions. The more information you can give your consultant, the better they will be able to help you.
A rectocele develops when the supportive wall of tissue that connects a woman’s rectum to her vaginal walls weakens. This can cause the front of a woman’s rectum to bulge into her vagina or protrude through her anal opening (known as a prolapse). Symptoms may include pelvic pain and discomfort, a feeling that she hasn’t completely pooped, and urinary incontinence.
Several factors can contribute to a rectocele, including age, prolonged childbirth, heavy lifting and chronic coughing. Women who are obese have a higher risk of developing this condition.
A rectocele repair procedure called posterior colporrhaphy can ease symptoms of a bowel hernia, including pelvic pain and discomfort, urinary incontinence and difficulty having a bowel movement. During the surgery, your doctor removes damaged tissue that’s no longer supporting your pelvic organs and stitches healthy tissue together for added support. Your provider can perform a rectocele repair through your vagina, an approach that leaves no scars.
During this outpatient procedure, your surgeon makes an opening in your vagina and repairs the hernia with a running 2-0 Vicryl suture. These sutures dissolve on their own within a few months and don’t need to be removed. With the surgeon’s nondominant finger in the rectum, an area 1 to 2 cm caudad and medially is dissected. Using a single No. 0 delayed absorbable suture, the surgeon plicates the levator muscle and fascia.