Genital prolapse and urinary incontinence is common among many women. A countless number of women suffer in silence because they do not understand their condition or the treatment options available to them. Dr. Kyle Wohlrab, MD, from the Women & Infants’ Division of Urogynecology and Pelvic Reconstructive Surgery has the answers to your questions.
What is reconstructive pelvic surgery?
Reconstructive pelvic surgery is the surgical restoration of the support of the pelvic organs (uterus, bladder or rectum). Although the exact causes of prolapse (a vaginal bulge) is unknown, experts hypothesize that a combination of age, number of children, weight, medical problems and genetics all play a factor in the weakening of the connective tissues that support these organs.
Most pelvic reconstructive surgery is to provide support, and can also be performed in those patients who have vaginal scarring from other surgeries or deliveries, patients with vaginal fistulas, or in patients who lack a vagina (which can be seen at birth with Mayer-Rokitansky-Kuster-Hauser Syndrome).
What does reconstructive pelvic surgery entail?
Surgery is tailored to the patient’s desires, location and severity of the prolapse. Surgery may be directed to restoring one aspect of prolapse, such as the bladder wall, or to the entire vagina including the bladder and posterior walls. Surgery relies on identifying the remaining normal tissue, and restoring support by rejoining that tissue.
In cases of severe prolapse, it may be necessary to add a synthetic, permanent material to help support a women’s own connective tissue. Surgery may be done vaginally, abdominally or through minimally invasive approaches. In cases of urinary incontinence, surgery ranges from injecting medicines near the bladder to supporting the bladder and/or urethra.
How long does the surgery take and will I have to stay in the hospital?
Surgeries range from 30 minutes to four hours depending on the severity and location of the prolapse. Not all surgeries require that you to stay in the hospital. You may be discharged the day of surgery. More involved surgeries for severe prolapse may require a two-to three-day hospital stay. Pre-existing medical conditions also factor into the length of your stay.
Will I be in a lot of pain after the surgery?
Pain is common after any surgery, but the amount of discomfort depends upon the type of surgery performed. Adequate postoperative pain management is very important to the recovery process.
Once I have the surgery, is there a chance the prolapse will return?
Most surgeries for prolapse will cure as many as seven out of 10 women. Unfortunately, no surgical procedure is completely effective in every individual. Recurrence can occur in certain individuals.
How long will I have to recover?
We recommend that you plan on restful recovery for six to eight weeks after surgery. During the recovery process, it is important to refrain from heavy lifting or vigorous exercise to allow healing of the surgical site. You should refrain from driving, swimming or bathing for at least two weeks after the surgery in most cases.
Will I be fully functional after the surgery?
The goal of pelvic reconstructive surgery is to restore anatomy to its normal location and function. We anticipate that you will be back to fully functional status after the recovery period.