Vaginal prolapse - How is it treated?
The treatment of vaginal prolapse may involve some simple measures to start with ("conservative treatment"). If the vaginal prolapse is more severe or simple treatments don't work, then your specialist will discuss operations to put things right.
Non-surgical (conservative) treatments
If the prolapse doesn't cause any symptoms, or the amount of nuisance caused is very small, then sometimes no treatment is needed. Prolapse is not usually a dangerous thing and treatment should only be considered if the prolapse is bothersome in some way.
Sometimes an operation is required to treat prolapse but there are often simple measures that can be considered first. These may also be useful for patients who don’t have too much trouble from their prolapse but want to prevent things from getting worse.
- Pelvic floor exercises can strengthen the pelvic floor muscles and improve symptoms.
- A high fibre diet will help to prevent constipation and reduce straining.
- Oestrogen treatment can reduce vaginal discomfort in women who have gone through the menopause, although they will not improve the prolapse itself.
- Vaginal pessaries
A pessary is a device that is inserted into the vagina by the specialist to support the prolapse and hold everything in the right place. Sometimes you will need to try a few different shapes and sizes to find the one that suits you best. The pessary will stay in all the time but it is not uncomfortable once it is in place.
The specialist will do a check-up every 3 to 6 months to change the pessary and make sure you are happy with it.
Some women experience side-effects from pessaries. These include interference with sexual intercourse, vaginal discharge and soreness.
Pelvic floor repair for vaginal prolapse
An operation may be needed if the prolapse does not improve with simple treatments and is causing bothersome symptoms. Surgical procedures for prolapse aim to support the walls of the vagina and hold the prolapse back in its correct place.
Anterior repair (anterior colporrhaphy)
This is an operation to treat a prolapse of the bladder (cystocoele). An incision is made on the front of the vagina. The bladder is then pushed back into the correct position and held in place with stitches under the skin.
You will have some dissolving stitches in the vagina. A pack will often be left in overnight and a catheter put in the bladder. These are usually removed the next day. Most people can go home after a couple of days, but it's important to take it easy for several weeks afterwards to let everything heal up securely.
Posterior repair (posterior colporrhaphy)
This is similar to an anterior repair but the operation is done for a bulge in the back wall of the vagina. The rectum is pushed back into the correct position and held in place with stitches under the skin.
Again, there are some dissolving stitches in the vagina. A pack will often be left in overnight and a catheter put in the bladder. These are usually removed the next day. Most people can go home after a couple of days, but it's important to take it easy for several weeks afterwards to let everything heal up securely. It is important to keep your bowels working well and laxatives can be helpful is necessary.
A vaginal hysterectomy is the removal of the uterus or womb. It is the commonest surgical procedure for uterine prolapse. The womb is removed through the vagina and the top of the vagina (vault) is closed with stitches. This does not require any cuts or stitches on the tummy.
Again, there are some dissolving stitches in the vagina. A pack will usually be left in overnight and a catheter put in the bladder. These are usually removed the next day. Most people can go home after a 3 or 4 days, but sometimes it can be a bit longer. It's important to take it easy for several weeks afterwards to let everything heal up securely.
Alternatives to vaginal hysterectomy
For women who do not want to have their womb removed, there are operations that help strengthen the tissues that support the womb and hold it in place. These may involve the use of a mesh (see below).
Sacrospinous fixation is an operation to treat a prolapse of the womb or the top of the vagina. Strong stitches are placed between the ligaments at the back of the pelvis and the top of the vagina. This provides strong support for the top of the vagina.
For women whose prolapse has come back after a previous prolapse operation, it may be necessary to insert a mesh to give extra strength to the tissues. A mesh is a fine net made from a type of soft plastic material. Once inserted, it stays under the skin providing support. Using mesh can reduce the risk of the prolapse coming back. Some women experience side-effects from the mesh including discomfort during sex, or an “erosion”, where the mesh is felt through the vaginal skin.
A piece of mesh is used to attach the womb and the top of the vagina to the bone at the bottom of the spine. This holds the womb very securely in place and stops it falling downwards. This operation can be done as a keyhole operation ("laparoscopic") or with an incision on the tummy ("open").
A colpoclesis operation involves closing off the vagina by stitching the front and back of the vagina together. Colpocleisis is only appropriate for women with a severe degree of prolapse who do not want to be sexually active. It is ideal for those who want to avoid a bigger operation as the recovery time is usually quick and you can go home sooner.