www.rfay.com.au

Dr Roger McMaster-Fay

Gynaecologist and Endoscopic Surgeon - Clinical Lecturer, Sydney University



Female Prolapse - the condition and its treatment


Female genital prolapse occurs when the support structures (ligaments and tissues), of the vagina and uterus are weakened, allowing the bladder, bowel or uterus to fall into the vagina. One in ten women will suffer from some form of prolapse at some stage in their life. The main contributing factor is childbirth but there are many other factors that are also associated with prolapse.

Prolapse can:

  • be in either the upper or lower vagina.
  • be in either the front (anterior) wall of the vagina involving the bladder or in the back (posterior) wall involving the bowel.
  • affect the uterus with or without any of the above.

To repair a prolapse requires surgery but a pessary can be inserted into the vagina to hold the organ(s) up. There are various types of pessaries, the most common being a plastic ring. Pessaries will not however cure a prolapse.

Up to one in three women who have prolapse surgery will require more than one operation. This does not mean that the first operation has necessarily failed but a different prolapse can occur after the surgery of the first prolapse.

I operate through the vagina for lower vaginal prolapses and laparoscopically (key hole surgery through the abdomen) for upper vaginal prolapses (see laparoscopic pelvic floor repair). Basically, my philosophy is to properly define the anatomical defect and repair it. Clinical examination and imaging techniques help but the true definition of the defect occurs with dissection at the time of surgery. I always use non-dissolving sutures for prolapse surgery and do not use mesh or tape.

I recommend any woman who has had a prolapse should avoid heavy lifting ever again.

With the modern imaging techniques of dynamic MRI scanning and transperineal ultrasound, gynaecologists are learning more about prolapse than they knew in the past. These tools are used mainly for research and most patients do not require these sophisticated imaging techniques. Most patients just need a competent and thorough vaginal examination. Even so, some prolapses do not become apparent until the patient is asleep under general anaesthetic at the time of surgery. Thus the surgeon cannot be absolutely precise about the exact specifics of the surgery that will be required before the operation. I will discuss this aspect as well as all other relevant aspects of the surgery with the patient prior to any decision to proceed to surgery.

Recovery after this type of female prolapse surgery is almost always very rapid, with most patients only needing to spend one or two nights in hospital, even with more complex repair operations.