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.