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Treatment of Vaginal Prolapse

Overview

Vaginal prolapse may be treated nonsurgically or surgically. Nonsurgical treatment involves using a pessary.

Surgical treatment involves repairing the vaginal defect that is causing the pelvic organ to prolapse into the vagina. For example, a cystocele is a weakness in the front wall of the vagina, near the bladder. A cystocele repair is repairing this weakness by sewing the fascia, or tough vaginal tissue, back together where it had broken. This repair is usually done through the vagina, however sometimes the break in fascia is in a place that requires the surgeon to repair the break through an abdominal incision. Surgeons will often, but not always, reinforce the repair with a piece of mesh or allograft material to prevent the prolapse from recurring. A rectocele repair is done in a similar way, except the repair is done on the back wall, or posterior wall, or the vagina.

Women who have a vaginal vault prolapse, or a drop in the top, or roof, of the vagina, require a different type of surgery. They may either have a vaginal or abdominal surgery. During the vaginal surgery, the surgeon reattaches the top of the vagina to supportive ligaments or structures in the pelvis;the uterosacral ligaments, sacrospinous ligaments, or ileococcygeous muscle. The abdominal approach is called an abdominal sacrocolpopexy and is done through a low midline abdominal incision or laparoscopically by using instruments through several small incisions. Regardless, the surgeon attaches a piece mesh from the top of the vaginal to the sacrum, which is the bony spine just above the tailbone. Oftentimes, an enterocele is repaired at the same time as a vault suspension surgery because vault prolapse often occur with an enterocele.

If a woman is no longer sexually active, she will be offered a type of vaginal surgery for prolapse that renders the vagina functionally inadequate for intercourse. This surgery, called a colpocleisis, closes the vagina completely. The introitus, or outside of the vagina, will appear quite normal, but the length will be about 1 inch (an average vagina is about 7 inches).

Women whose uterus is prolapsing will be offered a hysterectomy if they have completed childbearing. A gynecologist almost always performs this procedure. For details refer to the UW OBGYN website. If a woman who has uterine prolapse has not completed childbearing, then a hysteropexy can be considered if a trial of pessary use has failed. Hysteropexy involves leaving the uterus in place and anchoring it to supportive ligaments in the pelvis, sometimes synthetic material is used to reinforce the repair. However, these surgeries can be prone to recurrence and are not recommended unless a woman wants to bear more children.



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