There are several types of prolapse surgery but all of them try to fix the prolapse and prevent it from happening again.
You may consider surgery or your doctor may recommend it if you:
- made lifestyle changes and tried physiotherapy but they didn’t help
- cannot easily use or change a pessary
- need surgery for another pelvic condition (e.g. urinary incontinence)
What surgical options are there and how do they work?
There are five main operations used to treat vaginal prolapse.
Colporrhaphy uses stiches to repair or strengthen the tissue that supports the vagina. This involves making small cuts to your vagina. You will be given either an injection of medicine to numb the pelvic region (regional or spinal anaesthetic) or to put you to sleep (general anaesthetic). This surgery is usually for women with a stage one or stage two prolapse who have not had other prolapse surgery.
Hysterectomy removes the uterus. This can usually be done through your vagina without cuts to your skin but can also be done with several small cuts across the belly (laparoscopic or ‘keyhole’ hysterectomy) or one long cut across the belly (abdominal hysterectomy). You will be given a general anaesthetic to put you to sleep. A hysterectomy is usually for women with moderate or severe prolapse. This operation means you can no longer become pregnant.
Sacrocolpopexy attaches a piece of mesh to your tailbone (sacrum) to give your vagina and/or uterus permanent support. It can be done as keyhole surgery or with one longer cut to your belly (laparotomy) and you will be given a general anaesthetic to put you to sleep. This surgery is usually for women with a stage three or stage four prolapse or who have already had a hysterectomy. It may also be an option for younger women with a prolapsed uterus that don’t want to have a hysterectomy.
Colpocliesis stitches part of the vagina closed to prevent organs from moving into it. It is usually done under general anaesthetic but some women can have a local anaesthetic with sedation. Colpocliesis is usually for older women who haven’t had success using a pessary. This operation means you can no longer have penetrative sex.
What are the benefits and possible problems of each surgery?
| Benefits | Disadvantages | |
|---|---|---|
| Colporrhaphy | Can be done at the same time as other surgery (for example for urinary incontinence or a hysterectomy). | The same prolapse can return or a new one develop. Around two in 100 (or 2 per cent of) women have pain with sex that may need further treatment. There is a small risk of bladder problems (leaking, trouble emptying and infection) that may require treatment with medication or another smaller operation. |
| Hysterectomy | The same prolapse can return or a new one develop Around two in 100 (or 2 per cent of) women may have pain with sex after surgery that may need further treatment. You will no longer be able to have children There is a small risk of bladder problems (leaking, trouble emptying and infection) that may require treatment with medication or another smaller operation May lead to early menopause (even if your ovaries are not removed) |
|
| Surgery using a synthetic graft | Has a 50 per cent lower failure rate than surgery using just stitches (colporrhaphy) | The same prolapse can return or a new one develop Around two in 100 (or 2 per cent of) women may have pain during sex after surgery that may need further treatment There is a small risk of bladder problems (leaking, trouble emptying and infection) that may require treatment with medication or another smaller operation |
| Sacrocolpopexy | High success rate (nine in ten or 90 per cent of women are cured) | The same prolapse can return or a new one develop Around two in 100 (or 2 per cent of) women may have pain during sex after surgery that may need further treatment There is a small risk that part of the mesh will poke into the vagina and need to be treated with oestrogen creams or another, smaller operation to remove that part of the mesh There is a small risk of bladder problems (leaking, trouble emptying and infection) that may require treatment with medication or another smaller operation |
| Colpocliesis | The same prolapse can return or a new one develop Small risk of bladder problems (leaking, trouble emptying and infection) that may require treatment with medication or another smaller operation You will no longer be able to have penetrative sex |
You may have some or all of these side effects – or you may have none of them.
There are also risks with having any operation. These can include problems with the anaesthetic, bleeding which requires a blood transfusion, infection and blood clots.
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