Sometimes, the prolapse is not as severe as it first seems due to the cervix lengthening rather than both the uterus and cervix dropping.
A pelvic floor repair will remove the swelling in your vagina. It will stop any bleeding, pain or leak of urine. We do the operation through a cut in the wall of your vagina. We will usually push your prolapsed organs back into their normal positions above your pelvic floor. Then we do a repair operation, where we tighten the surrounding ligaments to hold your organs in place.
If you have a hysterocele, where your uterus has prolapsed, it may be best to remove the uterus along with your cervix. This operation is called a total vaginal hysterectomy. Without a uterus you cannot bear children and you will have no more periods. Although this may treat painful, heavy periods you need to be sure you never want to become pregnant before agreeing to a hysterectomy.
If you have a hysterectomy, we will usually leave healthy ovaries in place. They will continue to produce hormones until you reach the menopause. You will still have your usual premenstrual symptoms but will not have period pain or bleeding. During the menopause, you can still expect hot flushes and dizzy spells as usual. All women have a small chance, about one in 250, of developing cancer in their ovaries. Leaving them in at a hysterectomy does not increase this chance, but sometimes we remove healthy ovaries to prevent this. Discuss all the options with your gynaecologist. If your ovaries are not healthy, they should be removed at the same time as the hysterectomy. It may be possible to remove your ovaries and Fallopian tubes during a vaginal hysterectomy, but this gives a danger of damage to other parts of your pelvis. The operation to remove both Fallopian tubes and ovaries is called a bilateral salpingo-oophorectomy.
If you have a long cervix as the main feature of the prolapse, we may just remove this instead of your whole uterus.
Are there any alternatives?
Pelvic floor exercises or electrical implants - These may help to strengthen your pelvic floor muscles if your prolapse is minor.
Vaginal pessary - This is a plastic ring put inside your vagina to prevent any loose vaginal skin from coming down. It can be an effective and comfortable alternative to surgery, but does not work for everyone. With regular checking it may work for many years.
Laparoscopic surgery - This is an operation using keyhole instruments. We repair your pelvic floor through a number of small cuts in your abdomen rather than through your vagina.
Burch colposuspension - This is an abdominal operation to lift the bladder. If your bladder has prolapsed, especially when you also have problems with leaking urine, this may be the best treatment. There is a separate leaflet within this series covering this operation.
All of these alternative treatments may be improved by hormone replacement therapy (HRT) or by using hormone creams, called oestrogens. These help by increasing the blood supply to your pelvic organs.
What if you do nothing?
Without treatment your prolapse will usually become steadily worse. Although a prolapse can be very uncomfortable, it rarely causes a serious risk to your health. If your vaginal skin lies outside your body it will be damaged as it becomes sore, cracked and dry.
If you have a third degree prolapse it can sometimes put pressure on your ureters and kidneys, causing serious problems with passing urine. If the prolapse can be repaired, there is usually little sense in putting up with the symptoms.
Author: Dr David Hutchon F.R.C.O.G. Consultant Gynaecologist.
© Dumas Ltd 2006