Surgery To Correct A Pelvic Floor
Problem
It was late last year when I finally
decided I had to do something about my pelvic floor. I’d had a sensation of
“something coming down” for years – in fact, thinking back, probably since the
birth of my second child, nearly 20 years previously. Both my sons were born
with the aid of forceps, a known risk factor for developing a prolapse later,
because they stretch the vagina more than a normal delivery.
I knew what was wrong – I had a rectocele,
with noticeable slackening of the back wall of my vagina. It wasn’t life-threatening,
so I kept putting off doing anything about it. I tried doing pelvic floor
exercises, but they couldn’t improve the lack of tone inside my vagina. It was
when the discomfort, particularly when opening my bowels, started getting
worse, that I knew I had to make time to have the only treatment that would
sort it out. I needed a surgical repair. I’d been putting it off for years, not
because I was scared, but because there always seemed to be more important
things to do, like look after my sons or my patients.
As is often the case with pelvic repair
surgery, I didn’t need a hysterectomy. I just needed the back wall of my vagina
tightening up. My op was done under a general anaesthetic and, although I
stayed in overnight, I reckon I could have gone home the same day.
My surgeon, John Bidmead, is a
gynaecologist who specializes in pelvic floor repair work. He cut into the back
wall of my vagina, inserted some supporting sutures in the deep tissues, then
removed the excess stretched lining. I was left with a line of stitches along
the back wall of my vagina, and in between the vagina and anus. It felt like
the large episiotomies I’d had post childbirth, only tighter. I was sore and,
although I didn’t need morphine, I needed regular codeine and paracetamol in
order to sit comfortsbly. My post-op instructions were to avoid heavy lifting
and, most importantly, make sure I didn’t get constipated as any straining
would stretch the stitches.
This proved a problem because the codeine
bunged me up. Bran and prunes weren’t enough – I had to take laxatives as well.
A good learning experience! I made sure I had help with housework and ironing,
and had a few weeks of enforced rest when I couldn’t go to the gym.
It took a couple of weeks for my stitches
to heal and the soreness to subside, but in a month I was back at work. I felt
so much more comfortable, and going to the loo was no longer a struggle. And
yes, my sex life improved as well, not just for me, but for my husband too.
Here’s What I Would Advise
Symptoms
Many women have only a small change in
their anatomy, and the only thing they notice is that their vagina feels a
little less tight. In others, symptoms are more troublesome. The bladder is
supported by the pelvic floor muscles and the front wall of the vagina. If
either are weakened or stretched, the bladder may move downwards, and bulge
into the vagina – a rectocele. This can lead to difficulty passing a motion
and, ironically, the harder you push, the worse it becomes. In severe cases, it
may even be necessary to hold the vagina wall in place in order to empty your
bowels. Slackness of any part of the vagina can also lead to a decease in
sensation during sex for both women and men. If the ligaments supporting the
womb are stretched, then it drops down into the vagina. In the early stages
this may cause no symptoms, but in advanced cases the cervix may be felt just
inside the vagina entrance. Needless to say, this is not only uncomfortable,
but can make having sex impossible.
Sorting
it out
Top of the list are pelvic floor exercises.
Losing weight can help too. But these won’t help slackness in the walls of the
vagina, or ligaments supporting the womb. The only way to get them back into
shape is surgery. A vaginal repair operation may be all that is required to
tighten up either the front of the back wall. This is done under a general
anaesthetic and you may be able to go home the same day, or at most need one
night in hospital. An incision is made in either the front of back wall of the
vagina, supporting stitches are inserted into the deep tissues underneath, the
excess stretched vaginal skin is removed, and stitched closed. An anterior
repair (to the front wall) may be combined with a procedure to hitch up the
bladder, either with stitches or special tape. In this case you may need to
stay in hospital a couple of days. Surgery to repair the anterior wall is
usually quite pain-free afterwards; repairs to the back wall (a posterior
repair) can be more uncomfortable. If the womb has dropped, then it is possible
to lift and hold it in place using strong stitches or a special mesh. In the
past, this required open surgery via the stomach wall, but new techniques mean
the mesh is inserted via the vagina. The other option is a hysterectomy. This
may sound drastic, but it can usually be performed via the vagina, and often
means spending only one night in hospital.
Recovery
time
Again, this depends on what’s been done. I
know women who have gone back to sedentary jobs after three weeks, but most
need at least a month to six weeks off afterwards.
It’s never too late to improve your pelvic floor muscles!
Every woman who has had a baby needs to do
pelvic floor exercises, and it’s never too late to start. You can improve your
pelvic floor even in your nineties!
It’s
never too late to improve your pelvic floor muscles!
The pelvic floor muscles wrap around the
base of the bladder and rectum. You can do the exercises sitting or standing.
To strengthen the posterior muscles, you need to squeeze the muscle just above
your anus, as if you are trying to stop wind escaping. Don’t move your buttocks
or legs. For the front muscles, you need to imagine you are passing urine, and
trying to stop the stream. It may help to put a finger in your vagina, and
check that you can feel a gentle squeeze.
These have to be done regularly to be
effective – at least three sessions every day, for at least five minutes each
time, ideally more. Try and hold the “squeeze” of each set of muscles for at
least a slow count of ten. Over several months – you should feel the muscles
getting stronger, and you should aim to hold for longer – a slow count of 20
each time.
If you are unsure that you are doing the
exercises correctly, ask your GP for a referral to a specialist
physiotherapist. Once you have got the hang of doing the exercises properly,
and your muscles have improved, aim to continue doing at least one session a
day – for the rest of your life!
