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Prolapse & Incontinence Surgery. Miss Swati Jha Answers Patient FAQs...

Miss Swati Jha, Consultant Obstetrician & Gynaecologist
Claremont Clinics: Tuesday PM 

Prolapse
 
What is vaginal prolapse? 
Pelvic organ prolapse is a very common condition where one or more of the organs, such as the uterus, bladder or rectum, slip down from their normal position in the pelvis and bulge into the vagina. A woman’s lifetime risk of developing a prolapse is up to 20% and 1 in 10 women will require surgery.  Depending on the part of the pelvis affected, pelvic organ prolapse can be of the bladder (anterior prolapse), bowel (posterior prolapse) or of the uterus or vaginal vault (the top of the vagina after a hysterectomy) also referred to as apical prolapse.
 
What operations are available for prolapse?
It is important to understand that not every women with prolapse will require surgery. Mild prolapse can be addressed with pelvic floor muscle training and sometimes treatment can be with pessaries if you wish to avoid surgery. The operations offered depend on the type of prolapse. Usually the different types of prolapse occur in combination and this influences the type of surgery you will need. For bladder prolapse an ‘Anterior Vaginal Repair’ and for bowel prolapse a ‘Posterior Vaginal Wall Repair’ is usually done. When there is a prolapse of the uterus the usual treatment is a vaginal hysterectomy. All these operations are done through the vagina and do not involve cuts to your stomach.
 
What operation is required if I develop a prolapse after a hysterectomy or a previous prolapse operation?
If you develop a prolapse of your vaginal vault (top of the vagina after a hysterectomy), this can be addressed by an operation either through your vagina or your stomach. The operation though your stomach, called a Sacrocolpopexy, and the operation through your vagina is called a Sacrospinous fixation. There are advantages and disadvantages to both approaches which will be discussed with you fully prior to any surgery taking place. If you develop a recurrent prolapse after having a previous prolapse operation, further surgery depends on the part of the pelvis that has prolapsed again.
 
Is vaginal mesh used for prolapse surgery?
We do not use vaginal mesh for prolapse surgery at Claremont. However, in some circumstances such as prolapse of the vagina after a hysterectomy, synthetic mesh is used to lift up the vaginal vault and anchor it to your backbone. This operation is done keyhole through your stomach (called the Sacrocolpopexy) and is not the operation that has recently received adverse publicity in the news.
 
Will my operation last forever?
Unfortunately no prolapse operation is guaranteed forever. This is because the reasons you developed the prolapse in the first place are still present after your surgery and can occasionally make prolapse come back.  Pelvic floor exercises performed regularly (daily) can prevent a pelvic organ prolapse from recurring and should be done for 10 minutes every day.
 
Incontinence
 
I've been told I may need an operation for urinary incontinence?  What will this entail?
Urinary incontinence is of different types. Stress incontinence and urgency incontinence or it can be a combination and treatment depends on the type of urinary incontinence you have. Both types require conservative treatment in the first instance with physiotherapy and pelvic floor muscle exercises, bladder retraining and tablets. If these do not work, further tests are performed to investigate why your bladder is leaking (Urodynamics). Surgery depends on the type of urinary incontinence you have.
 
What operations are performed for stress urinary incontinence?
If you have stress urinary incontinence and conservative measures have failed, various operations are available. These include urethral bulking, synthetic tape operations, colposuspension and fascial slings. Each of these have advantages and disadvantages and need to be carefully considered before choosing an option.  Your consultant will discuss this in detail with you.
 
What operations are performed for urgency urinary incontinence?
For urgency urinary leakage, surgery is the last resort. This can involve Botox injections into the bladder and the risks need to be discussed in detail before proceeding with this treatment.
 
What are the risks and complications of prolapse and incontinence surgery?
No operation is without risk. All major operations have a risk of infection, bleeding and the need for a blood transfusion as well as clots. The risks vary depending of the type of operation and full details of these will be given to you so you can decide whether or not to proceed with surgery.
 
Is surgery painful? How long before I can start driving and exercising again?
No surgery is pain free but we give you plenty of pain relief to keep you comfortable afterwards. We don’t recommend you drive or fly for 6 weeks after major surgery and the same applies to going to the gym and swimming. Some operations which are smaller do not have these restrictions.
 
You may wish to visit http://www.swatijha.com for further information.

An initial private consultation with Miss Jha costs £200. For more information or to book an appointment, call our Private Patient Team on 0114 263 2114 or email privatepatients@claremont-hospital.co.uk.  It is not essential to have a referral letter from your GP but it is helpful to bring one.  
Date: 15/05/2018
By: Paula Lee
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