About one in 10 women who have had children require surgery for vaginal prolapse.
Prolapse is a weakness of the supporting structures of the vagina, allowing the pelvic organs to press against the vaginal wall, producing a bulge. This can cause pressure, discomfort, change in bladder or bowel function, and sometimes pain. Prolapse is not dangerous or life-threatening but it can be distressing and inconvenient, limiting physical and sexual activity.
A vaginal pessary is a removable device that is placed in your vagina to support the weakened and prolapsed walls of the vagina or uterus. The most common types of pessary are:
Some pessaries, such as ring pessaries, can safely remain in the vagina for several months without removal. Others, such as cube pessaries, must be removed and cleaned on a daily basis. Most pessaries are made from silicone, a soft, non-absorbent material that poses no risk to your health.
Most pessaries are placed to improve symptoms of prolapse of the uterus and or vaginal walls (see above). Sometimes your gynaecologist will suggest a pessary to prevent or reduce urinary incontinence during exercise. Pessaries are most suitable if you wish to avoid or delay surgery, e.g. if your family is not yet complete or if you have medical problems that will make surgery a risk.
An anterior wall prolapse is when the bladder is dropping down onto the front of the vagina, making a weakness or bulge. A prolapse of the front (anterior) wall of the vagina is usually due to a weakness in the strong tissue layer (fascia) that divides the vagina from the bladder.
This weakness may cause:
Another name for an anterior wall prolapse is a cystocele. An anterior repair, also known as an anterior colporrhaphy, is a surgical procedure to repair or reinforce the fascial support layer between the bladder and the vagina. It uses dissolvable sutures to re-enforce the fascial layer.
Most women stay in hospital up to two days following anterior repair surgery. Once you feel well and can pass urine with no difficulty, you can be discharged. It is recommended to take six weeks off work, especially if your job involves heavy lifting.
A prolapse of the back (posterior) wall of the vagina is usually due to a weakness in the strong tissue layer (fascia) that divides the vagina from the lower part of the bowel (rectum).
This weakness may cause:
Other names for the weakness of the back wall of the vagina include rectocele and enterocele.
The perineal body (the supporting tissue between vaginal and anal openings) also helps to support the back wall of the vagina. The perineum is the area that is often damaged when tears or episiotomies occur during childbirth. This area may need to be repaired along with the back wall of the vagina to give more support.
A posterior repair, also known as a posterior colporrhaphy, is a surgical procedure to repair or reinforce the fascial support layer between the rectum and the vagina. A perineorrhaphy is the term used for the operation that repairs the perineal body. Dissolvable sutures are used.
Most women stay in hospital for up to two days following posterior repair surgery. It is recommended to take six weeks off work.
Prolapse of the uterus generally occurs due to damage to the supporting structures of the uterus or vagina. Weakening of the supports can occur during childbirth, as a result of chronic heavy lifting or straining e.g. with constipation, a chronic cough, obesity, and as part of the ageing process. In some cases there may be a genetic weakness of the supportive tissues.
Vaginal hysterectomy is a procedure in which the uterus is surgically removed through the vagina. The operation is frequently combined with prolapse repairs and procedures for urinary incontinence.
Most women stay in hospital for two to three days after a vaginal hysterectomy. It is recommended to take six weeks off work.
For more information, read our hysterectomy information booklet [PDF, 435 KB].
A sacrospinous fixation is an operation designed to restore support to the uterus or vaginal vault (in a woman who has had a hysterectomy). Through a cut in the vagina, stitches are placed into a strong ligament (sacrospinous ligament) in the pelvis and then to the cervix or vaginal vault. The stitches can be either permanent or slowly absorbed over time; eventually they are replaced by scar tissue that then supports the vagina or uterus.
This procedure is often combined with a vaginal hysterectomy and/or surgery to treat prolapse of the bladder, bowel or stress urinary incontinence.
Most women stay in hospital for two to three days after a sacrospinous fixation. It is recommended to take six weeks off work.
Sacrocolpopexy is a procedure to correct prolapse of the vaginal vault (top of the vagina) in women who have had a previous hysterectomy. The operation is designed to restore the vagina to its normal position and function. A variation of this surgery called sacrohysteropexy corrects prolapse of the uterus.
Sacrocolpopexy is performed either through an abdominal incision or 'keyhole's (using a laparoscope), under general anaesthesia. A graft made of permanent synthetic mesh is used to cover the front and the back surfaces of the vagina. The mesh is then attached to the sacrum (tail bone) to hold the vagina up. The mesh is then covered by a layer of tissue called the peritoneum that lines the abdominal cavity; this prevents the bowel from getting stuck to the mesh.
Most women stay in hospital for two days after a sacrocolpopexy. It is recommended to take six weeks off work.