Vaginal Prolapse

Vaginal prolapse is a condition where the pelvic organs such as bladder, rectum, uterus, urethra, and small bowel protrude into the vaginal wall. Several types of vaginal prolapse conditions have been indentified and they include:

• Cystocele – Bladder protrudes into the vagina
• Rectocele – Rectum protrudes into the vagina
• Vaginal vault prolapse – Top portion of vagina herniates into vaginal canal
• Uterine prolapse – Uterus prolapse into the vagina
• Enterocele – Small bowel herniates into vagina

The main cause of vaginal prolapse is the weak muscles, tissues, and ligaments that support the vagina, surrounding tissues and organs. The factors that can cause vaginal prolapse include frequent lifting of heavy objects, chronic cough, severe constipation, menopause, and childbirth, previous surgeries in the pelvic area, advanced age, hysterectomy and obesity.

Women with prolapse may have different symptoms based on the type of prolapse. The signs and symptoms include difficulty in urinating and emptying bowel, enlarged and wide vaginal opening, vaginal lump, and the protrusion of tissues at the front and back wall of the vaginal.

Mesh Repairs for Vaginal Prolapse

Currently, more and more Specialist Gynaecologists are using a mesh repair to support the walls of the vagina. The mesh is stitched to the side wall and will also support the top of the vagina or the uterus. The recovery after surgery is very rapid and the recurrence rate of the prolapse is very small.

What is Mesh?

Mesh is a synthetic and permanent material that has been used by the surgeons for many years to correct hernias.

It is permanent.

It has a structure that allows one’s own tissue to grow into it and therefore creates a soft framework for support.

Mesh is suitable for many forms of prolapse. It is particularly indicated for the following conditions:

• Recurrent prolapse
• Severe prolapse
• To decrease the recurrence rate
• To conserve and suspend the uterus or the vaginal vault

Laparoscopic pelvic floor

Laparoscopic pelvic floor repair has been used for the last 10 years and has a good success rate. The operation may be prolonged and rather difficult but can have good results in the right hands.

Some complications

Failure/Recurrence

Obviously, there are the general risks of surgery but, more specific to pelvic organ prolapse, is the fact that there is a failure rate depending on the actual procedure. A standard (non-mesh) repair of the bladder may have up to 40% or 50% recurrence rate. However, the rate of failure or recurrence is very small with mesh repair.

Stress Incontinence

Stress incontinence may develop, even though it was not present prior to the operation. It is generally easily corrected.

Difficulty in passing stools/urine

There may be incomplete emptying of stools.

Mesh Extrusion

Mesh extrusion can occur at some sites and, uncommonly, the mesh may need to be removed.

Rectal/Bladder Damage

Damage to rectum or bladder can uncommonly occur.