Pelvic Floor Reconstruction and Incontinence Surgery

What is pelvic floor reconstruction and incontinence surgery?

Pelvic floor reconstruction is a surgical procedure that is used to treat severe pelvic organ prolapse in women. The pelvic floor includes the muscles, ligaments, connective tissue and nerves that support and hold pelvic organs in place. Examples of pelvic organs include the bladder, uterus (womb), vagina and rectum (bowel).

When the pelvic floor weakens and can no longer support the weight of pelvic organs, one or more of the pelvic organs may drop or ‘prolapse’ below their normal position to press against the walls of the vagina.

Symptoms of pelvic floor prolapse

The sagging or falling pelvic organs can cause pain, discomfort and pressure in the vagina. It can also cause urinary and bowel problems. Common symptoms of pelvic floor prolapse include:

• A bulge coming out of the vagina
• Discomfort or pain in the pelvis
• Problems with bowel movement
• Incontinence

Types of pelvic organ prolapses

Depending on the type of pelvic organ prolapse you have, your doctor may recommend different surgical options.

Vaginal prolapse

If you had a hysterectomy (a surgery that removes the womb) your doctor may recommend sacrocolpopexy. This procedure sews a synthetic mesh onto the prolapsed pelvic organs. The other end of the mesh will then be stitched to the lower part of the spinal column to keep the pelvic organs in place.

Rectal prolapse

If you have a rectal prolapse, your doctor may recommend rectal prolapse surgery. This procedure tightens the tissue between the vagina and rectum and is typically performed as traditional open surgery.

Bladder prolapse

If you have a bladder prolapse, your doctor may recommend reconstructive surgery for bladder prolapse. As part of this procedure, your surgeon will push the bladder back up into your pelvic region. Reconstructive surgery for bladder prolapse aims to secure the tissue between your vagina and bladder to keep your bladder in place.

Uterine prolapse

If you have a uterine prolapse, your doctor may recommend surgery to repair a prolapsed uterus to repair the weakened pelvic floor tissues. As part of this procedure, your surgeon may graft your own tissue, tissue from a donor or a synthetic material into the weakened pelvic floor structures. Another treatment option for a prolapsed uterus is a hysterectomy or removal of the uterus.

Why do you need pelvic floor reconstruction and incontinence surgery?

When non-surgical treatments (such as self-care measures like pelvic floor exercises) are deemed ineffective for more severe cases of pelvic organ prolapse, your doctor may recommend pelvic floor reconstruction as the option to restore the normal structure and function of your pelvic organs.

Surgery to correct pelvic organ prolapse can be performed through the vagina or through the abdomen, depending on the problem and the chosen treatment. The objectives of the surgery are to:

• Relieve your symptoms
• Restore normal vaginal anatomy
• Restore sexual function

What are the risks and complications of pelvic floor reconstruction and incontinence surgery?

While pelvic floor reconstruction surgeries are safe, these medical procedures still carry some risks and side effects, including:

• Infection
• Excessive blood loss
• Constipation
• Back pain

How do you prepare for pelvic floor reconstruction and incontinence surgery?

Before your surgery:

• Tell your doctor all the medicines and supplements you are currently taking. You may be asked to hold certain medications like blood thinners before your surgery.
• Follow your doctor's instructions regarding food and drink restrictions before your surgery.
• Make sure your bowels are empty during the procedure. Your doctor may ask you to take a laxative or enema before the surgery.
• Arrange for transport home and make sure you have a companion in the hospital. Since you will be given anaesthesia and pain medication, it will not be safe for you to go home on your own.

What can you expect in pelvic floor reconstruction and incontinence surgery?

Depending on your condition and the chosen treatment, reconstructive surgery to correct pelvic organ prolapse can be performed through the vagina or the abdomen.

Estimated duration

The procedure can take between 2 – 3 hours.

During the procedure

Generally, you will be given anaesthesia prior to the procedure. The surgery can be done by making cuts either in your vagina or abdomen. Likewise, your surgeon can also do laparoscopic surgery, wherein smaller cuts will be made in your abdomen using special instruments.

After the procedure

Depending on your circumstances, you will be allowed to go home within 24 hours or in 2 – 3 days.

After your surgery:

• You may experience minor temporary pain on your shoulders as a reaction to the carbon dioxide gas used during laparoscopic surgery.
• You may feel moderate cramping in your bladder or lower abdomen. These bladder spasms are usually temporary and will subside over time.
• A urinary catheter, which will be attached to you on the day of surgery to drain your bladder, will not be removed for 1 – 2 days after your surgery.
• You may encounter blood-tinged urine a few days after the procedure.
• At the end of the procedure, your surgeon may place a vaginal gauze packing to absorb excess blood loss and reduce haematoma formation. This packing will likely be removed a day after the procedure.
• Stitches in the vagina will dissolve on their own. When this happens, you may feel an uncomfortable pricking sensation and you may see the stitches. Due to the stitches, you may also have an odourless, creamy white discharge for 4 – 6 weeks.

Care and recovery after pelvic floor reconstruction and incontinence surgery

Depending on the type of surgery you underwent, your recovery time may vary. In general, you will need to take a few weeks off from work.

Wait at least 6 weeks before you engage in exercise, sexual intercourse and other physical activities. Typically, recovery time is longer for abdominal surgery than vaginal surgery.