What Is a Vaginal Prolapse Repair Surgery?
Surgical treatments are reserved for patients who have been unable to relieve the symptoms of their severe prolapse(s) through other means, and as a result their quality of life has significantly dropped. If non-surgical treatments have been unable to give you the relief you need, or you are looking for a quicker resolution from your prolapse and unable to make the commitment to non-surgical lifestyle treatments, then your doctor may discuss surgery with you.
There are several different vaginal repair surgical procedures available which aim to restore normal pelvic functions. Which one your doctor recommends will depend on the type of pelvic organ prolapse you’re experiencing, your health and your lifestyle. Multiple procedures can be completed at once, to repair all prolapses you are experiencing during one operation.
To learn more about pelvic organ prolapses and how they occur, visit our Types of Prolapse page.
Is Surgery Right For You?
There are a number of lifestyle treatments and other non-surgical treatments that can provide relief from your symptoms and improve your prolapse. To read more about these, visit our Treating a Prolapse Without Surgery page.
If non-surgical treatments have been unable to provide the improvement you need, and you are a good candidate for surgery, then your doctor may recommend surgery as relief from your prolapse. Vaginal prolapse surgery will normally only be carried out on women who have finished having children, as future pregnancy could cause the surgery to reverse and some surgeries remove the possibility of having future children.
Most vaginal repair surgeries have a high risk of complications. Combined with their relatively low success rates, it is crucial that you investigate first into non-surgical treatments and make an informed decision on whether surgery is your only option.
The following section provides an overview of what surgeries are currently available and how they work. Your doctor and surgeon will discuss your options with you, and determine which surgery is likely to result in the best success.
What Types of Vaginal Prolapse Repair Surgery Are Available?
Most surgeries are completed through the abdomen or vagina to reach the effected organs. They include the stitching of the prolapsed organ back into place and supporting the vagina and prolapsed pelvic organs walls with further stitches which will be followed by scarring and in some cases, using a biological or synthetic mesh. They are usually carried out under a general anaesthetic, meaning you’ll be asleep throughout.
As with all surgeries, you will have routine tests such as blood tests and heart tracing in the appointments leading up to your surgery. You will also need to share all medicines and allergies you have. Before the surgery you will be asked to fast, to avoid being sick due to the anaesthetic. You will also need to bring a completed bladder diary with you, to inform the surgeon on your bladder function.
Hysterectomy - Uterine Prolapse
A hysterectomy is the complete removal of the uterus through a small cut at the top of the vagina, and is often performed in a uterine prolapse emergency or when a uterine prolapse is severe. This procedure can be performed vaginally, or through the abdomen in an open operation. To reduce the risk of further prolapse, as a result of the loss of the uterus as support, the vaginal walls are then attached to healthy ligaments.
This surgery is only considered when the women no longer wants children. A hysterectomy has an 85% success rate at curing a uterine prolapse. However, hysterectomies are the leading cause of further pelvic organ prolapses. Therefore you must be committed to the laparoscopic procedure through the abdomen, more commonly known as keyhole surgery. One benefit of a laparoscopic procedure is the avoidance of damage to the entry of the vagina by surgical instruments if the surgery was otherwise completed through the vagina.
A suspension sling is a variety of a vault suspension surgery, where a synthetic mesh lining is added as additional support to the vaginal walls. The use of synthetic mesh in prolapse surgeries is only recommended within the context of research, as current evidence into the safety of the procedure is insufficient. You can read more about mesh repairs further down this page.
Anterior Vaginal Wall Repair - Cystocele, Urethrocele and Cystourethrocele
This surgery repairs the front wall of the vagina, the anterior wall. Once the affected organs, the bladder and/or urethra, are stitched back into place, the vaginal walls are then stitched to the supporting ligaments of the pelvic cavity. Strong stitches will be added to the front wall of the vagina to help strengthen it.
The total surgery can take between 30-90 minutes and can occur through the abdomen or through the vagina.
The anterior vaginal wall could be damaged as a result of:
- cystocele - bladder prolapse
- urethrocele - urethra prolapse
- cystourethrocele - both bladder and urethra prolapse
To read about other bladder prolapse surgeries, visit the Prolapsed Bladder Surgery page.
Posterior Vaginal Wall Repair - Rectocele or Enterocele
This surgery repairs the back wall of the vagina, the posterior wall. Similarly to the anterior vaginal wall repair, the posterior vaginal wall repair adds stitches to the back of the vagina once the small bladder (small intestine) and/or rectum are stitched back into place.
The wall will be strengthened against:
Obliterative (Colpocleisis) Surgery - Vaginal Prolapse
Arguably the most extreme pelvic surgery, this surgery involves the narrowing or the complete closing off of the entry of the vagina by sewing the anterior and posterior vaginal walls together up their length. This is with the aim of preventing prolapsed organs from falling outside the body.
As expected, this surgery prevents sex and vaginal childbirth and is most suited for older women who suffer from multiple medical conditions. This procedure has a 95% success rate but can cause complications where other health conditions arise. A reported 5% of women that undergo this procedure, regret the decision later on.
What Are the Risks and Potential Complications of Undergoing a Vaginal Repair Surgery?
All surgical procedures come with risks. Here are a few potential risks associated with vaginal repair surgeries:
- No fix! - The main risk of undergoing surgery is that it may not fix your prolapse. There is a 15% risk of the surgery not improving your symptoms and the prolapse returning. Some bladder and bowel issues can sometimes even get worse as a result of surgery. 29% of women require a second surgery and this figure does not account for the women that opt for non-surgical resolutions due to the failure of their first surgery.
- General anaesthetic - In rare cases (<0.01%) the use of anaesthetic can cause allergic reactions, breathing difficulties and even death.
- Infection - To reduce the risk of infection, you will be given a dose of antibiotics during the operation.
- Blood clots (deep vein thrombosis in legs and pulmonary embolism in lungs) - To reduce the 4% risk of developing a blood clot during surgery, medication will be provided throughout the operation. During your recovery you will be provided with elasticated stockings and you may be prescribed blood thinners if you remain at high risk. Do gentle exercise as soon as possible during your recovery to reduce this risk further.
- Chronic pelvic pain - You may experience temporary lower back and hip pain as you will have been placed in stirrups for your surgery.
- Pain in your buttocks - As well as the position you are put in during surgery, pain in your buttocks can be a result of the location some of the ligaments are that may have been touched during the surgery. You may experience a degree of buttock pain for a few months following your surgery.
- Pain during sex - Some women experience pain during sex that does not improve. This risk is increased if your surgery was competed through the vagina.
- Bladder infection (cystitis) - Treatable with a course of antibiotics.
- Damage to nearby organs - During surgery, damage can occur to the nearby organs such as the bladder, bowel or vagina.
- Difficulty emptying the bladder - As a result of damage done to your bladder during the surgery.
- Mesh erosion - If a synthetic vaginal mesh has been used, it can move and begin to erode through your vaginal walls.
If your prolapse has caused severe damage to your vaginal walls, they may not be repairable through surgical stitches alone. This is when surgeons can decide to use a biological or synthetic mesh, stitched in place to the inside of the vagina to help strengthen it and guard against future prolapses. The mesh can be referred to as TVT, which stands for Transvaginal Tape.
As you may be aware through recent media attention, there is a high rate of complication and pelvic pain associated with the use of synthetic mesh. With reports stating that up to 18% of women suffer mesh extrusion where the mesh breaks through the vaginal wall. Sometimes this is so severe that these women require further surgery to remove a portion, or all, of the mesh.
If you have this or any other post-operative symptoms that worry you, make an appointment to see your surgeon or doctor as soon as possible.
How Long Does it Take to Recover from Vaginal Repair Surgery?
Depending on the severity of your prolapse, your overall health, age, and the type of surgery you have had, recovery times differ. However, you would normally be able to carry out your normal activities in four to eight weeks.
No surgery can repair your pelvic floor muscles. You must treat a prolapse as a life long condition that requires you to continue completing daily pelvic floor exercises following your recovery, to increase their strength and reduce the chance of recurrence. If you have had any biological or synthetic mesh fitted, you will need to continue pelvic floor exercises to ensure the mesh does not stretch which could cause mesh erosion where the material breaks into the vagina.
There are a few things to expect following your surgery, and a few things to look out for:
- Uncovered conditions - Occasionally, a vaginal prolapse repair uncovers other underlying conditions or previously unrecognised damage to the organs. Your doctor will discuss whether these require further treatment following your recovery, but where possible (and previously agreed), repairs to these organs will occur during your initial vaginal repair surgery. This will likely add time to your recovery.
- Future prolapses - Prolapses are a life-long condition. To avoid them occurring again it is essential that you perform pelvic floor / Kegel exercises daily following your recovery. This is especially important if you have had any synthetic mesh fitted as it can move or stretch causing secondary issues.
- Lifestyle changes - Non-surgical prolapse treatments should be followed to prevent future prolapses; such as eating well to avoid constipation, and maintaining a healthy weight.
- Time in hospital - Certain surgeries, such as sacrospinous fixation, may require a few nights stay in hospital before you are discharged.
- Bleeding - Some vaginal bleeding in the hours following a vaginal surgery is normal, however if there is a large amount, if it is foul smelling, or you are concerned for any reason - contact your doctor.
- Vaginal discharge - A degree of white/yellow creamy vaginal discharge is expected following your surgery however if it does not return to normal throughout your recovery or it is unpleasant in colour or smell, please speak to your doctor.
- General anaesthetic - Vaginal prolapse surgery is usually carried out under a general anaesthetic, but may require a spinal anaesthetic resulting in numbness to your lower body throughout the operation. Anesthetic can make you unwell, therefore you may not be discharged from hospital until you are able to keep down food and move confidently.
- Catheter - For all pelvic surgeries, expect to have a catheter fitted to drain urine from your bladder. This catheter may be removed a few hours following your surgery, whilst you are still in hospital, or may be removed at a follow-up appointment 24 hours after your surgery. You may experience swelling following the removal of your catheter, causing an inconsistent urine flow. If you experience this, or any persistent stinging, please inform your doctor.
- Gauze wadding and oestrogen cream - Following some vaginal surgeries, you may have gauze wadding saturated in oestrogen cream placed into your vagina to promote healing. This can be removed after a day or two. Most women report great improvments in pain once this wadding is removed.
- Sex - You should not have sex for at least two months following your surgery. After which you may notice different or less sensation. This can be improved by building pelvic floor / Kegel exercises into your routine. If your discomfort is a result of damage to the vagina by surgical instruments, your doctor or a physiotherapist will be able to advice on the best pelvic floor exercises for you.
- Using the toilet - Once any swelling from the catheter has gone, you should expect to be able to use the toilet as normal. It is important that you eat a healthy diet to avoid constipation and the accompanying straining which could put pressure on your wound.
- Rest and exercise - In the first few weeks following your surgery, rest is vital and promotes a speedy recovery. You should expect to feel more tired than normal. Do no lifting (even of children or shopping bags) and no strenuous exercise. However, gentle exercise such as walking around your house is recommended to prevent a blood clot occurring. A general rule is, if it hurts or causes any discomfort, stop doing it! For the first few days you may be able to only complete a few steps around the house.
- Driving - Some insurance companies do not insure drivers for a fortnight, or more, following a surgery. Your surgeon may also suggest not spending too much time sitting for the first fortnight and only driving once you do not experience any pain when making an emergency stop - this may be up to a month following surgery.
- Work - You may need to bring a certificate from the hospital with you to start work again, which is available on request. You should not rush back to work and take your recovery at your own pace.
Follow-up appointments - You will be invited to an out-patient clinic six months after your surgery to check your recovery.
What Are the Alternatives to Surgery to Fix a Prolapse?
Even if your prolapse is severe, there are many non-surgical treatments which can relieve the symptoms and reduce the severity of your prolapse. These take commitment, but generally have higher success rates than surgery for most:
- Vaginal pessary - Vaginal pessaries come in all shapes and sizes to fit your body and your prolapse. They are the most common treatment for women suffering from a severe prolapse but wish to have children in the future. Pessaries can be removed as needed, and take the pressure off your pelvic floor so you can concentrate on strengthening it.
- Pelvic floor / Kegel exercises - Daily pelvic floor exercises are essential in maintaining a strong pelvic floor. They are recommended for everyone, regardless of age and health. Learn more about completing pelvic floor exercises here. If you want something more effective with quicker results, try an electronic pelvic toner, proven to improve prolapses as a result of strengthening your pelvic floor.
To read more about non-surgical treatments for a vaginal prolapse, visit our Treating a Prolapse Without Surgery page.
Central Manchester University Hospitals NHS Foundation Trust. (2014). Saint Mary's Hospital, Gynaecology Service - Warrell Unit. An operation for prolapse - Colpocleisis. Information for Patients. [online] Central Manchester University Hospitals NHS Foundation Trust, 2014
Central Manchester University Hospitals NHS Foundation Trust. (2014). Saint Mary's Hospital, Gynaecology Service - Warrell Unit. An operation for prolapse - Vaginal Hysterectomy. Information for Patients. [online] Central Manchester University Hospitals NHS Foundation Trust, 2014
Cutner, A. Kearney, R. Vashisht, A. (2007). Laparoscopic uterine sling suspension: a new technique of uterine suspension in women desiring surgical management of uterine prolapse with uterine conservation. [online] BJOG, 2007 [viewed 23/03/2018] Available from: https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/j.1471-0528.2007.01416.x
Davila, G. W. (2015). Vaginal Vault Suspension. [online] Medscape, 2015. [viewed 23/03/2018]. Available from: https://emedicine.medscape.com/article/1848619-overview
Giarenis, I. Robinson, D. (2014). F1000Prime Reports. Prevention and management of pelvic organ prolapse. [online] 6(77). [viewed 27/03/2018]. Available from: http://f1000researchdata.s3.amazonaws.com/f1000reports/files/9008/6/77/article.pdf
International Urogynecological Association, IUGA. (2012). Uterosacral Ligament Suspension. [online] International Urogynecological Association, IUGA, 2012 [viewed 23/03/2018]. Available from: http://www.pelvic-health-surgery.com/prolapse/prolapse/Uterosacral-Ligament-Suspension.pdf
Mayo Clinic. (2018). Pulmonary embolism. [online] May Clinic, 2018 [viewed 23/03/2018]. Available from: https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/symptoms-causes/syc-20354647
MHRA. (2014). A summary of the evidence on the benefits and risks of vaginal mesh implants. [online] MHRA, 2014 [viewed 26/03/2018]. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/402162/Summary_of_the_evidence_on_the_benefits_and_risks_of_vaginal_mesh_implants.pdf
Musgrove Park Hospital NHS. (2016). Obstetrics & Gynaecology, Sacrospinous Fixation. [online] Musgrove Park Hospital NHS, 2016 [viewed 23/03/2018]. Available from: http://www.tsft.nhs.uk/media/45380/sacrospinous-fixation.pdf
NHS. (2015) General anaesthesia [online] National Health Service, 2015 [viewed 23/03/2018]. Available from: https://www.nhs.uk/conditions/general-anaesthesia/
NHS. (2015) Laparoscopy (keyhole surgery) [online] National Health Service, 2015 [viewed 23/03/2018]. Available from: https://www.nhs.uk/conditions/laparoscopy/
NICE. (2015). Urinary incontinence in women: management, 1 Recommendations [online] National Institute for Health and Care Excellence, 2015 [viewed 14/03/2018]. Available from: https://www.nice.org.uk/guidance/cg171/chapter/1-Recommendations#physical-therapies
NICE. (2017). Sacrocolpopexy with hysterectomy using mesh to repair uterine prolapse [online] National Institute for Health and Care Excellence, 2017 [viewed 05/04/2018]. Available from: https://www.nice.org.uk/guidance/ipg577
Royal Berkshire NHS Foundation Trust. (2017). Patient Information: Surgical repair of vaginal prolapse: anterior / posterior vaginal wall (or pelvic floor) repair. [online] Royal Berkshire NHS Foundation Trust, 2017 [viewed 23/03/2018] Available from: http://www.royalberkshire.nhs.uk/patient-information-leaflets/Vaginal%20prolapse%20surgery%20gynaecology.htm
Royal College of Obstetricians and Gynaecologists. (2013). Information for you: Pelvic Organ Prolapse [online] Royal College of Obstetricians and Gynaecologists, 2013 [viewed 26/03/2018]. Available from: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/gynaecology/pi-pelvic-organ-prolapse.pdf
Stanton, S. Thakar, R. (2002). The BMJ. Management of genital prolapse. [online] 324(7348), p 1258-1262. [viewed 23/03/2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123216/