Approximately fifty percent of women who have given birth experience some degree of pelvic organ prolapse affecting the vagina. These conditions may include:
- Vaginal Prolapse. This occurs when the top of the vagina loses its support and drops, most commonly in women who have had a hysterectomy. Symptoms may include difficulty urinating, bowel dysfunction, painful intercourse, vaginal pain, loss of bladder control, and a sensation of heaviness in the vaginal area.
- Small Bowel Prolapse (Enterocele). This condition occurs when the small intestine presses against and pushes the upper vaginal wall, forming a bulge or hernia.
- Anterior Vaginal Prolapse (Cystocele). A cystocele forms when the front wall of the vagina bulges, leading to a loss of support for the bladder that rests against it. Symptoms may include urinary incontinence, pelvic pressure or heaviness, and lower back pain.
- Posterior Vaginal Prolapse (Rectocele). This occurs when the rectum bulges into or out of the vaginal wall. It may lead to difficulty with bowel movements.
Proper diagnosis is essential for effectively treating pelvic support conditions. Open communication with your physician about symptoms is key to identifying the exact cause. Depending on your symptoms and the specific type of vaginal prolapse, treatment options may include targeted exercises, lifestyle modifications, pessary use, dietary changes, reconstructive surgery, or obliterative procedures to narrow and shorten the vagina.
Dr. Ali Ghomi is a board-certified gynecologic surgeon with extensive experience in diagnosing and treating pelvic organ prolapse. If you have questions or would like to schedule a consultation at our urogynecology office in North Jersey, please call (862) 657-3150 or request an appointment through our secure online form today.
Vaginal Prolapse Treatment
To treat or repair vaginal prolapse, “apical” suspension techniques are used to restore support to the top of the vagina (vaginal vault). Common procedures include:
Abdominal Sacral Colpopexy (ASC).
Performed through an abdominal incision—either laparoscopically or robotically—ASC uses graft material to reinforce the vaginal walls. Straps formed from the graft are attached to the ligaments over the sacrum, supporting and suspending the vagina over the pelvic muscles and spine.
Uterosacral or Sacrospinous Ligament Fixation.
This procedure involves suspending the vagina using the patient’s own uterosacral or sacrospinous ligaments. Graft material may be used to enhance the durability of the repair.
Small Bowel Prolapse (Enterocele) Treatment
The surgical correction for enterocele is called sacral colpopexy. This procedure involves using polypropylene or biologic grafts to close the apex of the vagina and correct the bulge or herniation of the small bowel. Access is gained through an intra-abdominal approach. A Y-shaped mesh is placed over the vaginal apex and re-suspended to the sacrum, restoring proper anatomical support.
Anterior Vaginal Prolapse (Cystocele) Treatment
Cystocele repair lifts the front wall of the vagina to better support the bladder. This can be performed vaginally or through an abdominal approach during sacral colpopexy.
In an anterior colporrhaphy, an incision is made in the front vaginal wall. The vaginal skin is separated from the bladder wall, and the weakened deep vaginal tissue is identified. Strong tissue adjacent to the frayed edges is then sutured together, lifting the bladder and restoring structural support.
Because this area of the pelvic floor endures significant pressure (e.g., from coughing or lifting), up to one-third of women may experience a recurrence after anterior colporrhaphy. To reduce the risk, Dr. Ghomi may use graft material to reinforce the repair.
Posterior Vaginal Prolapse (Rectocele) Treatment
When the muscles at the vaginal opening are stretched or separated during childbirth, this may be corrected with a perineorrhaphy, or alternatively through an abdominal approach during sacral colpopexy.
To address the bulge caused by rectocele, a posterior colporrhaphy is performed. An incision is made in the back vaginal wall, separating the vaginal skin from the rectal wall beneath. Once the weakened areas of deep vaginal tissue are located, the strong adjacent tissue is sutured together to rebuild the wall between the rectum and vagina. In some cases, Dr. Ghomi may use graft material to reinforce the repair.
Pelvic Reconstructive Surgery FAQs
Dr. Ali Ghomi is a board-certified gynecologic surgeon with extensive experience diagnosing and treating pelvic organ prolapse.
What is Pelvic Floor Reconstruction Surgery?
Pelvic floor reconstruction surgery is a surgical procedure that is designed to restore strength and integrity to the bottom of the pelvic floor by addressing each of the prolapsing organs one by one. This is either done by reconstructing the supporting layer of the pelvis or by removing the organ.
How Painful Is Prolapse Surgery?
Patients may experience some pain immediately after surgery, but this doesn’t generally last longer than a few days or weeks at the most. For women recovering from the surgery, long-term pain is very rare.
What Is the Recovery Time for Pelvic Reconstructive Surgery?
On average, most patients can resume their normal daily activities around three weeks after surgery. If the doctor was required to make a vaginal incision, the patient may feel some pain during sex so it’s recommended to avoid sexual activity for four to six weeks post-surgery.
Can a Prolapse Correct Itself?
Yes, the condition may sometimes heal on its own if the symptoms are mild. We recommend making changes to your lifestyle by way of increasing activeness on a daily basis if possible in order to progress healing.
What Kind of Medical Specialist Performs Pelvic Reconstructive Surgeries?
These surgeries can be performed either by a urologist or a gynecologist, depending on the situation. We recommend asking your doctor about their experience and outcomes performing female pelvic organ surgery so you can minimize the chances of any complications resulting from the surgery.
How Successful Is Pelvic Floor Surgery?
Success rates for pelvic floor surgery can range from 80-90%. However, like many other procedures, there is a chance of recurrence or additional prolapse, so it’s important to follow Dr. Ghomi’s recommendations after surgery.
