Pelvic floor weakness

The pelvic floor consists of tissue, tendons and muscles. It functions are a support apparatus for the organs in the pelvis. As a person ages, it becomes increasingly weaker. Consequently, it can result in a drop in the pelvic floor. In the worse case, organs such as the uterus, bladder, rectum or vagina can drop so far down that the vagina bulges or presses outward. In such cases, the pelvic floor must be strengthened surgically. In addition, the uterus is also lifted and fixed to the pelvis. In the case of uterine prolapse, the lifting and hanging of the uterus is known as hysteropexy.

Pelvic floor surgery, prolapse surgery

Pelvic floor surgery or prolapse surgery are complex procedures. They usually combine pelvic floor strengthening and tissue lifting with fixation of the uterus (hysteropexy), the rectum (rectopexy) or the vagina (colpopexy). Sometimes the uterus is removed at the same time instead of being refixed; this is the preferred procedure for post-menopausal women.

There are different surgical procedures to fix pelvic floor prolapse. The choice of procedure depends on which organs are affected by the prolapse. The vaginal surgical method with access over the vagina is usually selected.

What preparations are carried out before the procedure?

Different clarifications and examinations are undertaken before the procedure. Ultrasound examination and vaginal endoscopy are among the standard clarifications. Sometimes an ultrasound or a CT examination are also carried out. All blood-thinning medication must be discontinued before the procedure takes place. The surgery is usually carried out under general anaesthetic along with all the usual pre-operative assessments.

How is the operation carried out?

Depending on the extent of the pelvic floor drop and the prolapse of the organs, different procedures are used or combined with each other. Principally it involves tissue lifting, tissue strengthening and fixing the uplifted pelvic floor.

In the last few years, a procedure in which a plastic net is inserted o strengthen the pelvic floor has proven to be effective. This is fed via the vagina to the pelvic floor. The net is lifted over small incisions in the abdominal wall until the pelvic floor has been uplifted once more. The net and also the uterus are fixed to the available ligaments or the bones in the pelvis.

The examination takes between one and two hours.

What is the success rate of this procedure?

The success rate of the surgery is 90%.

What are the possible complications and risks of this procedure?

This is a low-risk operation and generally proceeds without complications. As with all surgery, the operation may lead to infections, post-operative haemorrhaging or blood clots in rare cases. Sometimes there are growths in the abdomen.

What happens after the operation?

After the surgery, the patient is monitored during the recovery phase as they wake up from the anaesthesia. If everything proceeds normally, you can usually leave hospital three to five days after the operation. You should avoid lifting heavy objects and major physical exertion for some time after the surgery, and refrain from sexual intercourse for a while. You should not bear down hard during bowel movements. Stool softeners (pessaries) can also be used.

After the operation, targeted pelvic training, which is often started before the operation, should be done again.