Vaginal prolapse is a relatively common gynecological problem. Those with this condition can have one of several types: prolapse of the uterus, prolapse of the bladder or prolapse of the rectum. Vaginal prolapse treatment, including vaginal prolapse surgery, is important to consider if the condition is bothersome to the patient.
Historically, many concerns with female reproductive anatomy were brushed aside and said to be normal. Although prolapse is common, it is not something you must simply "live with" and accept. It is important for patients with prolapse to see a medical professional who has knowledge of prolapse diagnosis and treatment. This may be a traditional OB/GYN, but there are also specialized urogynecologists or female pelvic medicine and reconstructive surgeons who may be best suited for complex vaginal prolapse surgery.
Diagnosing a Vaginal Prolapse
Physicians usually make a diagnosis by viewing the uterus, bladder, and/or rectum falling into the vagina during a speculum examination. This examination would typically be done if a patient expressed symptoms of prolapse to their general practitioner or gynecologist. These symptoms can include a sense of pressure or bulge within the vagina; urinary issues, such as incontinence; or gastrointestinal problems, such as constipation or incomplete emptying. Ultrasound can assess the pelvis for other pathology that could be contributing to prolapse or could have an impact on the potential treatment.
Vaginal prolapse occurs in some people with risk factors and in some people without. According to research from the International Urogynecology Journal, some known risk factors are previous vaginal deliveries, age and body mass index. The more deliveries a patient has had, the higher the risk of prolapse becomes. Although no one can change their age, it is possible that a change in weight, if someone is obese, will have positive outcomes on prolapse regression.
Options for Vaginal Prolapse Treatment
Planning for prolapse treatment should take the patient's goals into account. A watchful waiting approach can be considered for those who can tolerate their symptoms and prefer to avoid treatment.
Some non-invasive and non-surgical options that can be used independently or in combination include vaginal pessary and pelvic floor muscle physiotherapy exercises. Vaginal prolapse surgery can be considered but should be tailored to the patient's specific needs, addressing all aspects that are bothersome to the patient.
Reconstructive vs. Obliterative Surgeries
There are many types of surgery that fall under the heading of vaginal prolapse surgery, but they can be divided into two categories: reconstructive or obliterative. Reconstructive options are used when a patient wants vaginal intercourse to be possible post-operatively. Obliterative procedures are rarely done, but they may be useful for patients who cannot tolerate more extensive surgery or who are not planning on future vaginal intercourse.
When reconstructive vaginal prolapse surgery is considered, patients who retain a uterus must consider a simultaneous hysterectomy (removal of the uterus). This decision is more relevant when there is prolapse specifically of the uterus. Another important consideration for patients is whether they need simultaneous surgery for incontinence.
Is Vaginal Prolapse Surgery Generally Successful?
Surgical outcomes depend on a few factors:
- Severity of the vaginal prolapse
- Severity of the patient's symptoms
- Surgeon experience level
- Patient expectations
Although there are generally good outcomes following surgery, there may be failed cases where the surgery is unsuccessful in the short or long term. Research published in Women's Health reports a recurrence of vaginal prolapse, including the need for repeat surgery, at up to 30 percent. Research published in the International Urogynecology Journal outlines some recognized risk factors for relapse, which include injury to the levator ani, a higher stage of prolapse before surgery and a family history of prolapse. This last factor may imply some difference in tissues from one person to another that creates a certain predisposition.
In conclusion, prolapse is common and treatable. Surgery is one treatment option category, but there are many procedures that can be considered. A thorough understanding of symptoms and examination findings is integral to helping both the patient and the surgeon make the right decisions about treatment.
