Pelvic Floor Repair Surgery

Pelvic floor repair surgery is a procedure to correct pelvic organ prolapse, where pelvic organs (e.g., bladder, uterus, rectum) slip downward due to weakened muscles and tissues. It aims to restore normal anatomy and relieve symptoms.

Types of repairs:

• Anterior repair (for bladder prolapse).
• Posterior repair (for rectal prolapse).
• Apical repair (for uterine/vaginal vault prolapse).

Why is it Performed?

Your gynaecologist may recommend this surgery if you have:

• Symptoms of prolapse: Bulging sensation, pelvic pressure, difficulty emptying bladder/bowel, urinary incontinence, or discomfort during sex.
• Failed non-surgical treatments: Pelvic floor physiotherapy or pessaries did not work.
• Impact on quality of life: Prolapse interferes with daily activities.

Before Surgery

• Consultation: Discuss risks, benefits, and alternatives (e.g., pessaries, lifestyle changes).
• Pre-operative tests:
  • Pelvic exam, ultrasound, or MRI.
  • Urine tests to rule out infection.
• Preparation:
  • Fasting: No food/drink for 6–12 hours before surgery.
  • Bowel prep: May be required for posterior repair (your surgeon will advise).
  • Medications: Adjust blood thinners (e.g., aspirin) as directed.
• Arrange support: Plan for help at home for 2–4 weeks post-surgery.

During the Procedure

1. Anaesthesia: General or spinal anaesthesia (you’ll be asleep or numb).
2. Surgery:
   1. Vaginal approach: Incisions in the vaginal wall; prolapsed organs are repositioned and tissues reinforced.
   1. Abdominal/laparoscopic approach: Small abdominal incisions (if mesh is used or for complex cases).
   1. Hysterectomy: May be included if the uterus is prolapsed.
3. Closure: Dissolvable stitches or mesh placement (if needed).
4. Duration: 1–3 hours (varies with complexity).

Risks and Complications

• Common (temporary):
  • Pain, swelling, or bruising.
  • Light bleeding/discharge for 2–4 weeks.
  • Temporary urinary retention or constipation.
• Rare but serious:
  • Infection, bleeding, or blood clots.
  • Mesh erosion (if used): Pain, discharge, or discomfort during sex.
  • Prolapse recurrence (10–20% risk).
  • Bladder/bowel injury (rare).

Recovery

In the hospital:

• Stay for 1–2 days (depending on approach).
• Catheter may remain temporarily to drain urine.

At home:

• Rest:
  • Avoid heavy lifting, bending, or exercise for 6–12 weeks.
  • No sex, tampons, or swimming for 6–8 weeks.
• Pain management: Use prescribed medications or paracetamol.
• Bowel care: Eat fibre-rich foods, stay hydrated, and use stool softeners if needed.
• Pelvic floor exercises: Begin once cleared by your physiotherapist.

Return to work:

• Desk jobs: 2–4 weeks.
• Physical jobs: 6–12 weeks.

Long-Term Effects

• Prolapse recurrence: Regular check-ups and pelvic floor exercises reduce risk.
• Sexual activity: Most resume normal function but discuss concerns with your gynaecologist.

Alternatives to Surgery

• Pessary: A removable device inserted into the vagina to support organs.
• Pelvic floor physiotherapy: Strengthens muscles to improve symptoms.
• Lifestyle changes: Weight loss, treating chronic cough, avoiding heavy lifting.

Frequently Asked Questions

Q: How long until I feel normal?
A: Full recovery takes 3–6 months, but most daily activities resume within weeks.

Q: Will the prolapse come back?
A: Possible, but healthy habits (e.g., pelvic floor exercises) lower the risk.

Q: Can I lift my grandchildren after surgery?
A: Avoid heavy lifting for 3 months to protect healing tissues.

eGynaecologist Advice:

• You should seek gynaecological consultation if you develop raised temperature >38°C, heavy bleeding, severe pain, or you are not able to urinate after the pelvic floor repair procedure.
• You should discuss the surgical preventive actions that your gynaecologist can take to reduce the risk of apical or vault prolapse if you are undergoing hysterectomy procedure.