More Information:
- Well women's health care
- Abnormal cervical smears - colposcopy
- Family planning & contraception - hormonal, implants, IUD
- Infertility & ovulation induction
- Abnormal uterine bleeding - office endometrial biopsy
- Menopause & hormone replacement therapy
- Urinary incontinence
- Prolapse & pelvic floor reconstruction
- Dermogynaecology clinic & vulvar disease
- Vulvar skin care
- General anaesthesia or spinal block
- Self referral tests
Prolapse & pelvic floor reconstruction
Prolapse refers to the displacement of the uterus or adjacent pelvic organs from their normal anatomical positions within the pelvis. The pelvic floor is a muscular diaphragm which assists in providing support to the bladder, rectum, vagina and uterus. Through childbirth the various ligaments and fascial supports are damaged and with time weakened so that the genital organs begin to fall within the vagina. This usually occurs around the time of menopause when the lack of oestrogens is often a contributing factor to prolapse as are also chronic cough and constipation.
Symptoms of prolapse include a lump at the vaginal entrance which may be the uterus or the bladder and rectum bulging through particularly when the patient is standing. Other symptoms of pelvic organ prolapse include urinary incontinence and less commonly poor bowel control. Vaginal relaxation with an open gaping introitus can be responsible for a lack of sensation particularly during sexual intercourse. This can be surgically corrected by performing a pelvic floor reconstruction returning the genital organs to their correct anatomical arrangement.
Pelvic organ prolapse once established usually becomes worse with the passage of time and requires surgical correction. Surgery once again consists of a pelvic floor reconstruction which includes a vaginal hysterectomy together with a repair of the anterior vaginal wall (bladder), the posterior vaginal wall (bowel) and also the perineum or entrance to the vagina. This is often performed under a spinal block with the patient only slightly asleep as this allows a more rapid post operative recovery. Hospitalization is usually for 3-4 days with complete recovery and return to work after 4-6 weeks.
When prolapse involves mainly the anterior vaginal wall and the bladder causing incontinence of urine, the preferred treatment is the insertion of a tension-free vaginal tape (TVT) below the urethra and bladder neck to provide the appropriate support.