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Pelvic Floor Repair

Pelvic Floor Repair: What is it, risk, preparation before and post surgery care | KKH

Pelvic Floor Repair - What it is

What Is The Pelvic Floor?

This is an area in the body which is made up of muscles and supporting tissues (fascia) to provide support for the womb, bladder and rectum. If the pelvic floor is weak, the bladder, rectum and the womb may protrude out of the vagina.

Why Is The Pelvic Floor Weak?

This is often due to previous deliveries, menopause or excessive straining such as chronic cough, constipation or the presence of a pelvic mass.

What Are The Symptoms?

  • Heavy, dragging sensation
  • Lump that can be felt or seen at the vagina
  • Urinary difficulties (e.g. incomplete emptying of the bladder)
  • Bowel difficulties (e.g. constipation, incomplete emptying of bowels)
  • Pain
  • Infection
  • Bleeding

What Is Pelvic Floor Repair?

It is an operation performed from the vaginal route to restore the support of bladder and rectum and to remove excess vaginal skin so as to reduce the protruding bladder and / or rectum.

When the prolapse of the bladder & rectum is severe; there maybe a need to use synthetic meshes, that act as an extra support system. There are various systems used like the Gynaemesh and latest being the Prolift mesh system. It may be done together with other procedures to correct urinary incontinence or to remove the womb.

The objectives of the operation are to relieve your symptoms, restore vaginal anatomy and sexual function.

 

What Are The Risks Associated With Pelvic Floor Repair?

It is a relatively safe operation. However, like all surgical operations, complications may occasionally occur. These include:

  • Bleeding
  • Infection
  • Injury to surrounding tissues (e.g. blood vessels, bladder or rectum)
  • Blood clot formation in the legs or lungs
  • Recurrence of the lump
  • Slow return of bladder and bowel function
  • Dyspareunia is pain during sexual intercourse, which is uncommon when a mesh system is inserted
  • Mesh erosion, where the mesh system comes through the vaginal skin and this usually does not cause symptoms. The rate is approximately 10 to 15% and requires a small procedure to remove the protruding mesh and repair the vaginal skin

Pelvic Floor Repair - Symptoms

Pelvic Floor Repair - How to prevent?

Pelvic Floor Repair - Causes and Risk Factors

Pelvic Floor Repair - Diagnosis

Pelvic Floor Repair - Treatments

Pelvic Floor Repair - Preparing for surgery

​What Happens Before Surgery?

  1. Blood tests, electrocardiography (ECG) and a chest X-ray may be done to ensure that you are in optimal health for surgery.
  2. A hormonal preparation containing estrogen (i.e. cream or pessaries) may be given to you before the operation if you are already menopausal. This helps to improve your vaginal tissues for surgery and healing.
  3. You would generally be admitted one day before your surgery.
  4. You will be given preparation to clear your bowel and have the pubic area shaved.
  5. You are not allowed to eat or drink after 12 midnight.

What Happens In The Operating Theatre?

The surgery may be done under regional anaesthesia (which involves the injection of a local anaesthetic medicine into the spine to numb the lower half of the body) or general anaesthesia (when you would be asleep throughout the procedure). The anaesthetist will discuss the advantages and disadvantages of both methods with you.

The surgery will be performed through the vagina. There will not be any visible scar on the abdomen.

At the end of the operation, the vagina will usually be packed with an antiseptic pack.

A catheter will be inserted into the bladder as there may be initial difficulty in urination after the procedure.

Painkillers, laxatives and antibiotics will generally be prescribed after the procedure.

Pelvic Floor Repair - Post-surgery care

What Happens After Surgery?

  1. After the operation, you may experience:
    • Tiredness - you should rest and gradually increase your activity until you feel fit to return to your normal activities.
    • Yellowish vaginal discharge - this is from the yellow antiseptic gauze that is commonly used to pack the vagina.
    • Discomfort in the lower abdomen and in the vagina. This is to be expected and painkillers should help to relieve the discomfort.
    • Vaginal bleeding - mild to moderate amount of reddish watery discharge after surgery is quite normal. This may last up to 3 weeks after surgery. You may want to wear a protective sanitary pad (but not a tampon) during this period.
  2. One day after surgery, your vaginal pack will be removed. You will usually be allowed to drink and eat. You are encouraged to move around. Blood and urine investigations may be done.
  3. On the second day after surgery, the catheter will be removed and you will be allowed to pass urine normally.
  4. You may be discharged on the second day after surgery if you are well and have no problem passing urine. The stitches will dissolve by themselves.
  5. You should refrain from:
    • Strenuous exercise until you are feeling fully fit. You may return to normal activity after 4 weeks
    • Using tampons, douching and sexual intercourse for 4 weeks
    • Carrying heavy weight (> 5kg) in the long run
  6. You should return immediately to the Urogynaecology Centre (during office hours) or the Women's 24-hour Clinic if any of the following occurs:
    • Heavy vaginal bleeding
    • Foul smelling vaginal discharge
    • Severe abdominal distension and / or pain not relieved by painkillers
    • High fever
    • Pain when passing urine
    • Inability to pass urine

When Do I Return For Follow-up

You will be reviewed in the clinic at 1 week, 1 month, 6 months, 12 months and then yearly thereafter. It is very important to keep your follow-up appointments to ensure the best possible results.

Pelvic Floor Repair - Other Information

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