New Advances in the Repair of Vaginal Weakness

There have been significant advances in the techniques for repairing the various potential weaknesses that can develop in the vagina (called vaginal prolapse). Many women with pelvic prolapse are uncomfortable with a feeling of heaviness or weight in the vaginal area, a feeling of "sitting on a ball", discomfort during sexual activity, difficulty with bowel movement, or loss of urinary control.

Besides these symptoms, significant pelvic prolapse can also result in kidney damage or damage to the bladder making it difficult for the bladder to empty and predisposing to urinary infection. With new techniques of repair utilized, these problems can usually be corrected without the need to continue to live with the problems wear a ring (pessary) in the vagina. These advanced techniques of repair include:

Repair of the Anterior Vaginal Wall: When the urethra drops (the tube that carries the urine from the bladder to the outside) women frequently have loss of urine with coughing, sneezing, or change in position (stress incontinence). Returning the urethra to its proper position with a sling procedure can now restore long-term urinary control. There is a new sling technique with minimal postoperative discomfort to allow the sling to be entirely performed via the vagina without harvesting any tissue for the sling.

Dropping down of the urethra is frequently accompanied by dropping of the bladder as important that both be repaired simultaneously. With current techniques of cystocele repair, the defect through which the bladder herniates into the vagina is closed with strong tissue with excellent long-term success.

Repair of the Top of the Vagina: Most commonly, weakness at the top of the vagina occurs after hysterectomy. This bulge from the top of the vagina is called an enterocele. Frequently, an enterocele is associated with the entire vagina dropping down, known as vaginal vault prolapse.

These weaknesses at the top of the vagina are repaired through the vagina by closing the defect in the ligaments at the top of the vagina and fixing the top of the vagina to these ligaments. Also, the hernia sac which contains the intestine is closed. These reconstructive procedures are performed entirely through the vagina without causing loss of vaginal length or narrowing of the vagina.

Repair of the Back and Opening of the Vagina: Weakness at the back of the vagina usually involves the rectum bulging through the back wall of the vagina (called a rectocele) causing a feeling of the bowel movement getting stuck and the need to push excessively to evacuate the bowel movement. Frequently, a rectocele co-exists with weakness of the muscles at the opening of the vagina. This muscular weakness can lead to loss of sensation during sexual activity or a general feeling of the vagina being "too loose".

Repair of weakness in this area involves bringing the separated muscles back together to strengthen both the back of the vagina and restore the muscle tone at the vaginal opening.

Summary

Symptoms of vaginal weakness are effectively treated with new surgical techniques performed entirely via the vagina with minimal postoperative discomfort and excellent results. These successful vaginal techniques now make it possible to repair any combination of vaginal weaknesses that used to require major abdominal surgery and prolonged recovery. Thus, many women who previously opted for the option of avoiding surgery or wearing a ring (or pessary) in the vagina may now elect to repair the problem and significantly improve their quality of life.