The pelvic floor is composed of a set of muscular and ligamentous structures, which extend in the shape of a fan, connecting the bones of the anterior aspect of the pelvis (pubis) with the bones of the posterior aspect (sacrum). In this way it provides structural support to the organs of the abdomen, such as the bladder, uterus or rectum.
Because of its configuration and location, the pelvic floor is intimately related to all the functions of the female genital tract and therefore, any injury or problem may affect functions such as urination or defecation.
What is genital prolapse?
Genital prolapse is the descent of the female genital organs through the vagina. This displacement of the structures can be mild and asymptomatic or severe, and cause a lot of discomfort, discomfort and affect functions such as urination, defecation or sexual intercourse. In some cases it can be very debilitating and considerably affect the quality of life.
This pathology can affect women of any age, although it tends to be more frequent in postmenopausal women who have had one or more vaginal deliveries.
What are the symptoms?
Genital prolapse can manifest or symptom in many ways. The symptoms will depend on the type and degree of prolapse.
The initial reason for consultation is usually the sensation of a lump at the vaginal or vulvar level, or that the tissues or structures in the vagina are out of place. Generally, the more advanced the prolapse, the more severe the symptoms.
Symptoms that can be observed in most types of vaginal prolapse include: pressure in the vagina or pelvis, painful intercourse (dyspareunia) and/or bulging at the opening of the vagina, among others.
There are other symptoms that may be associated with specific types of prolapse, such as:
- Difficulty emptying the bladder: may be associated with anterior prolapse (cystocele, urethrocele) or uterine prolapse. More rarely to a posterior prolapse (recto-enterocele).
- Difficulty emptying the bowel: This may be indicative of posterior prolapse (rectocele, enterocele or vaginal vault prolapse) and is usually related to a defect in the fibrous septum connecting the vagina and rectum (rectovaginal fascia).
- A woman with difficulty emptying her bowel may need to place her fingers on the back wall of the vagina to help evacuate completely. This is known as fingering or splinting.
- Problems such as constipation can be both a symptom and a consequence of prolapse.
- Stress urinary incontinence is related to the causative factors of prolapse.
- A wide, wide vaginal opening with a short, thin perineum is also a common physical finding in patients with prolapse.
What is pelvic floor surgery?
In some cases, surgery is the best option for correcting prolapse, especially when other more conservative treatments have not been effective or have not resolved the problem. Most surgical treatments for pelvic floor problems can be performed as outpatient procedures or with a minimal hospital stay of 1 or 2 days.
Prolapse surgery involves correction of the defect, restoration of anatomy and recovery of support and support of the pelvic floor structures.
There are many techniques available and, depending on the type of prolapse, the goal is to individualize and use the most appropriate technique for each patient and their symptoms. The approach can therefore vary according to the case and can be either vaginal or laparoscopic (abdominal).
How is a prolapse corrected?
When we find a symptomatic prolapse the first thing we do is a good exploration and confirm which are the prolapsed structures. Once this is done, we design a custom operation to correct each defect individually.
If the prolapsed structure is the uterus, we can opt for corrective surgery with or without preservation of the uterus, depending on the patient’s preferences.
If hysterectomy (removal of the uterus) is performed, it is always accompanied by an additional technique to reinforce the vaginal support (high dome suspension) to reduce the risk of prolapse recurrence.
What are the operations for prolapse correction?
- Correction of cystocele
- Correction of rectocele
- Vaginal hysterectomy with dome suspension.
- Manchester operation (cervical amputation).
- LeFort operation (Colpocleisi)
- Richter operation
- Vaginal hysteropexy (elevation of the uterus via vaginal)
- Laparoscopic colposacropexy (vaginal vault elevation via laparoscopy).
- Laparoscopic hysteropexy (uterus elevation via laparoscopy).
How long is the recovery time?
The great advantage of both vaginal surgery and minimally invasive (laparoscopic) surgery is the reduced post-operative convalescence time.
Recovery is usually rapid, with minimal pain during the postoperative period, thus facilitating the return to an active life within a few days.