Surgery

A generalized weakness of the vaginal muscles and ligaments is much more likely to develop than are isolated defects. If a woman develops symptoms of one type of vaginal prolapse, she is likely to have or develop other types as well. Therefore, a thorough physical examination is necessary for the surgeon to detail what surgical steps are necessary to correct the vaginal prolapse completely. The typical surgical strategy is to correct all vaginal weaknesses at once.

Surgery is usually performed while the woman is under general anesthesia. Some women receive a spinal epidural. The type of anesthesia given usually depends on how invasive and lengthy the surgery is expected to be.

Laparoscopic surgery is a minimally invasive surgical procedure that involves slender instruments and advanced camera systems. This surgical technique is becoming more common for securing the vaginal vault after a hysterectomy and correcting some types of vaginal prolapse such as enteroceles or uterine prolapses.

• Vaginal vault prolapse: This is a defect that occurs high in the vagina, so it may entail a surgical approach through the vagina or abdomen. Generally, the abdomen is the entry of choice for a severe vaginal vault prolapse. The surgical correction of this condition usually involves a technique called a vaginal vault suspension, in which the surgeon attaches the vagina to strong tissue in the pelvis or to a bone called the sacrum, which is located at the base of the spine.
  
  
• Prolapsed uterus: For women who are postmenopausal or do not want to have more children, a prolapsed uterus is usually corrected with a hysterectomy. The common approach for this procedure is through the vagina.
  
  
• Cystocele and rectocele: These are corrected through the vagina. Typically, the surgeon makes an incision in the vaginal wall and pushes up the organ. The surgeon then secures the vaginal wall to secure the organ in its normal position. Any excess tissue is then removed, and the vaginal wall is closed. The surgeon may use a surgical procedure called a laparoscopic bladder suspension, or modified Burch procedure, to correct a cystocele. If urinary incontinence is present, the surgeon may need to support the urethra. This usually involves a procedure called a bladder neck suspension.

Women who undergo surgery for vaginal prolapse repair should normally expect to spend 2-4 days in the hospital depending on the type and extent of surgery involved. After surgery, women are usually advised to avoid heavy lifting for approximately 6-9 weeks.