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Pelvic Floor Restoration

Pelvic Floor Restoration Surgery

Pelvic floor muscles are a wide group of muscles under your pelvis that form the pelvic ‘floor’. The muscles are banded together, a bit like a hammock, to protect and hold in place your bladder, uterus and bowels. The ‘floor’ has two openings in it by which it controls, by relaxing and tightening at will, your vagina and your anus (rectum). When the ‘floor’ relaxes and contracts the openings, fluids and solids such as urine and faeces are able to leave the body.

What causes problems with my pelvic floor?

The pelvic floor can be a problem area for some women.  Giving vaginal birth to several children, prolonged coughing fits, old age, obesity, a reduction in your oestrogen level resulting in weaker muscles, can together or individually lead to a weakened pelvic floor. A weakened pelvic floor can, in turn, lead to leakage of urine when one laughs, coughs or sneezes.

More seriously, if the floor is weakened sufficiently it can mean that your uterus is unsupported by it. If your uterus hangs low enough this is known as a prolapsed (or fallen) womb. Problems with a low-slung or weakened pelvic floor can lead to, for example, urine and bowel leakage, kidney infections and more.

Can my pelvic floor be restored to normal?

Yes, the problem can be fixed. To help you restore the state of your pelvic floor to normal, ‘floor’ exercise is undertaken. This involves you consciously tightening and relaxing the muscles yourself. Ideally, a physiotherapist would have previously given you advice on how to carry this out. 

Some medicines may allow the bladder to relax enough to let the bladder empty properly. It may be that medicine is prescribed that encourages the sphincter muscle in the neck of the bladder to tighten up to prevent urine leakage. If all else fails then it may well be that surgery is the only option left.

What does the surgery involve?

Surgery is carried out in our private clinic under general anaesthetic.  The front walls of your vagina will be rebuilt and the internal organs such as your bladder, uterus and bowel, put back into their correct position.

If your pelvic floor has collapsed before, a type of mesh can be used to strengthen your vaginal wall.  The mesh can be made synthetic or animal derived. The type of mesh used can be discussed with your gynaecologist.

Mesh may be used also if your rectum has fallen (prolapsed) to require extra support. This will also apply to your small bowel. If your uterus has dropped down out of position then, depending on the severity, it may have to be removed altogether (hysterectomy) or, if it can be saved, then pulled upwards and held in position. For younger females who want to have children or more children the latter is the more satisfactory choice. Here again, mesh is used to keep the uterus up and in position. 

Less invasive surgery in the form of keyhole surgery (Laparoscopy) is used. An incision (cut) is made, more popularly because of fewer complications, through the stomach, and a fibre optic cable is used to put the mesh in place. General anaesthetic is not required for keyhole surgery.

Will there be complications?

There can be, as with most other invasive operations. Your gynaecologist will discuss these with you in more detail to make you better informed and to reduce any fears you may have.

There may be risks where you have difficulty getting rid of urine. You may well encounter pain and perhaps bleeding from your vagina. Infection can also occur. Damage to your bladder or bowel may happen. As with some operations, thrombosis is a risk. Thrombosis is where a blood clot forms in a main vessel blocking the natural flow of blood to or from the heart.

When mesh is used to support and strengthen the wall of the vaginal area, sexual intercourse may be painful due to swelling in the area.

How long does the surgery take?

The operation to repair a sagging pelvic floor can take up to 1 hour to repair. It does, however, vary from person to person.

What will happen in the recovery period?

Your gynaecologist will use dissolvable stitches. They tend to dissolve anywhere between 1 to 3 weeks. Other types of stitching can take up to nearly 7 weeks but your surgeon will decide which stitching material to use.

You may experience some painful constipation and difficulty urinating, together with minor back pain for the first few days. Bleeding and infection may occur but are not very common. If a laparoscopy is used to repair the pelvic floor the chances for complications will be greatly reduced.

You will need to take care with washing so as not to get the wound infected.

What is the recovery time?

It can take up to 3 months to fully recover from this type of surgery. It will, however, vary from person to person. During this period, you should not lift heavy items or indulge in strenuous exercise. Activities like swimming and walking are fine.

What can I expect from the surgery?

In the majority of cases, surgery is successful. You will feel an improvement to the way your bowel and bladder function. You may well find yourself enjoying sex more as a result of having your pelvic floor restored because the vaginal area may feel tightened up.