The pelvic floor is attached to the inside of your pelvic bones and ligaments. It stretches across the lowest portion of your pelvis. The organs like uterus, bladder, rectum, and intestines press up and down on your pelvic floor during day to day activities. The pelvic floor is a very complex layer and can be damaged when stressed too much. The most common surgery for cystocele is a pelvic floor repair, which are simple surgical repairs of the pelvic floor.
Anterior Vaginal Repair
It is used to repair or reinforce the weakened front layers between the bladder and the vagina. The ultimate aim of the surgery is to relieve the symptoms of vaginal bulging to improve bladder function, and does not interfere with sexual function. Although it has a high success rate, the chances of recurrence are more.
The patient is kept under general anesthesia. An incision is made along the centre of the front wall of the vagina, which begins near the entrance and extends to the top of the vagina. Using absorbable stitches the weakened and diseased layers are repaired. The superfluous vaginal skin is also removed. Sometimes mesh or some other reinforcement material is used to strengthen the vaginal walls in case of a repeat operation.
A catheter is also placed in the bladder temporarily to drain the fluids. A pack is inserted into the vagina to reduce bleeding into the tissue. Both the pack and catheter are removed after 2 days. The urine output will be collected and measured. A small machine is placed on your tummy will be used to check that your bladder has completely emptied.
The injuries may take 3 months or so to heal completely. Any physical activity that puts pressure is to be avoided. Regular follow up visits and checkups are necessary.
Posterior Vaginal Repair
If the prolapse is on the back wall of the vagina, it is largely due to the weakened tissues which divide the vagina from the lower part of the bowel. Posterior repair; reinforces the weakened layers between the rectum and the vagina. The aim of the surgery is to improve bowel function, and to ensure it does not interfere with the sexual functions as well.
The surgery is performed under general, anesthetic. The common method is to make an incision along the centre of the back wall of the vagina. Absorbable stitches are used to repair the weakened portions. In case of repeat surgery, a mesh may also be used. Placement of catheter and pack inside vagina are standard post surgery procedures. The post operative conditions of all vaginal surgery are similar.
Along with the bladder, if the uterus also drops down into the vagina, it has to be removed surgically. In extreme cases, ends of the tissues will protrude outside through the vaginal opening. The surgery is performed under general or spinal anesthetic.
During the surgery an incision is made at the top of the vagina just around the cervix. The bowel and the bladder are pushed away from the uterus. The connecting tissues are all detached and the uterus is removed. The wounds are then sutured. Additional stitches are necessary to support the vaginal walls during surgery. Catheter and pack will also be inserted into the vagina which can be removed later. Post operative conditions are the same as for that of other vaginal surgeries.