Urogynaecology is the subspecialty of medicine for diagnosing and treating pelvic floor disorders in women such as urinary incontinence and prolapse of pelvic organs such as bladder, uterus, rectum, vagina and small bowel.
Vaginal prolapse is a condition where the pelvic organs such as bladder, rectum, uterus, urethra, and small bowel protrude into the vaginal wall. Several types of vaginal prolapse conditions have been identified and they include:
The main cause of vaginal prolapse is the weak muscles, tissues, and ligaments that support the vagina, surrounding tissues and organs. The factors that can cause vaginal prolapse include frequent lifting of heavy objects, chronic cough, severe constipation, and menopause, and childbirth, previous surgeries in the pelvic area, advanced age, hysterectomy and obesity.
Women with prolapse may have different symptoms based on the type of prolapse. The signs and symptoms include difficulty in urinating and emptying bowel, enlarged and wide vaginal opening, vaginal lump, and the protrusion of tissues at the front and back wall of the vaginal.
Surgery is done to restore vagina and the pelvic organs back to their respective positions and provide symptomatic relief. It helps to strengthen the muscles around the vagina and prevent further damage of pelvic floor muscles. Vaginal prolapse surgery may be done through laparoscopy or open surgery. Various surgical procedures are performed to correct the prolapse of different pelvic floor organs.
In the enterocele repair, the ligament and muscles are reattached to the top of the vagina with the help of sutures. Suturing the vaginal walls will only repair the defect and will not provide support to the apex of vagina to the supporting struictures. Often, following the enterocele repair other procedures may be performed to correct the abnormalities that are found together with enterocele. Other surgeries done with enterocele are for cystocele, rectocele and vaginal vault prolaspe.
Meshes are available in various sizes and shapes. It reduces the risk of recurrence of prolapse and enables the growth of new tissue through which this tissue incorporates the mesh into surrounding area.
Other surgical procedures to correct vaginal vault prolapse include
Every surgical procedure may be associated with certain risks and complications. The possible complications after the surgeries for vaginal prolapse include pain, infection, bleeding, recurrence of symptoms, injury to ureters, and perforation of rectum and bladder. The complications are usually mild and can be treated accordingly.
The advantages of choosing minimally invasive surgery is that the defects can be clearly identified, incisions are small, post-operative pain and discomfort is reduced, shorter duration in hospital, and less time for recovery.