Vaginal Surgery
It is quite surprising what can be done this way and vaginal surgery is the source of all those jokes about Gynaecologists re-building car engines through the letterbox. In this regard, it can be complex and challenging.
Largely, vaginal surgery is performed for prolapse or urinary incontinence or both. I utilise your own tissues when performing prolapse surgery. Results vary based on a patient's weight, age, hormone status, degree of prolapse, constipation, chronic asthma, past surgery, lifestyle etc. There are 3 areas to operate on, either alone or in any combination:
Front wall prolapse (Anterior Vaginal Repair)
This involves the bladder +/- the urethra
30% chance it will fall down again within 6 weeks to 6 years
50% chance incontinence will get better in the short term
5% chance incontinence will be worse after surgery or appear when it wasn't there before
10% chance you will develop some urinary urgency. This usually resolves within 4 weeks but may persist
Small chance of putting a hole in the bladder. This usually heals well but you will have a catheter in the bladder for 7-10 days.
Small chance of kinking or tying off a ureter, possibly requiring a 2nd operation to fix the ‘oops'. A cystoscopy is done during the operation to check for this.
Swelling and bleeding in the area can make it too difficult to empty the bladder and you may need to go home with a catheter for a week before returning for a Trial of Void.
Back wall (Posterior Vaginal Repair)
This is done when the bowel is pushing up through the back wall of the vagina or when childbirth has stretched the supports and there is a bulge of this area.
Some women who have lost vaginal sensation, have a Posterior Repair to improve sensation during sex - a 'designer vagina'
The long term results are good, with a low recurrence rate
There is a small chance of vaginal scarring, making sex painful
There is a very small chance of significant scarring making sex impossible. This is more likely with multiple attempts at surgery
There is a small chance of a bowel injury
Vault Suspension (top of the vagina)
The top of the vagina can prolapse, a bit like a sock turning inside out -- Putting this back can be difficult and the method often (not always) depends on the presence or absence of a uterus, your age, degree of prolapse and how many previous operations have been done.
It is often combined with a repair of the front and back walls
It may involve use of mesh. If so, then I would refer you on to someone who does this type of work.
Post-op: An In-Dwelling Catheter (IDC) is often present for 24 - 48 hours depending on the operation. It will remain for 7-10 days if the bladder was opened for any reason or if you do not pass your Trial of Void.
Vaginal Pack - this is a long piece of gauze dressing, used to apply pressure to the vaginal walls and reduce blood loss. It will give you a ‘full bowel' feeling and is usually left in until the next morning unless you find it too uncomfortable. It does not hurt to remove.
Pain after surgery varies with the procedure but most women find it tolerable and require little pain relief.
Bowel Function is very important. I suggest taking one Movicol each morning and 2 x Plain Coloxyl each night in the week leading up to surgery. Make sure you continue taking stool softeners after surgery and have plenty of fluids. Constipation can be a big problem, especially after a Posterior Repair.
Urinary Tract Infections occur in about 3% of patients.
Recovery is always 6 weeks. Don't do any heavy lifting or straining. If you weigh 100+ kg, this includes heaving yourself up into 4 wheel drive. Take it easy, because if you stretch the newly formed scar tissue, you will get a recurrence. A few words about Continence (urethra and bladder neck) operations:
As a rule, I repair prolapse and then review the continence issues later.
Although prolapse surgery can cure incontinence, it can also reveal incontinence which was hidden. A large bladder prolapse can ‘kink’ off the urethra which is why some women find that as their prolapse gets worse, their incontinence gets better.
Urodynamics is done prior to continence surgery
A review is performed 4-6 weeks later.