Vaginal Repairs—front and back end

You have just been told you need surgery to correct a drop or prolapse in the vagina–the bladder has dropped or the rectum is bulging–things are just not as tight as they used to be!

You search the internet and see diagrams of prolapses but I find they really don’t show you what is going on–so I am going to start collecting pictures to try and help explain this all to you, so it makes sense.

Let’s take a look at a few prolapses first.

This video shows a mild rectocele–one that isn’t causing any problems at all–so doesn’t need to be fixed at all.  Follow the first rule of prolapse–IF IT AIN’T BROKE—DON’T FIX IT!

Now–in all fairness–if you have to press down on the bulge to get a bowel movement to come out–that is called SPLINTING–then you ARE having problems.  You don’t want to have to do that for the rest of your life!   Or–maybe you do?  Up to you!  A rectocele is not going to kill you after all.

You also have an option of using a pessary (see the pessary post).  The pessary needed to correct a rectocele is usually something like the DONUT or the Gehrung–and these pessaries don’t allow for intercourse (sex)–and are a bit of a bugger to get in and out.  We use lots of donut pessaries—in women who are no longer sexually active–and they work fine.  Some women don’t want to have surgery–and some women are not in good enough health for surgery.

This is a donut pessary–it literally is the size of a donut!

 

Milex Pessary: Donut

The pictures on the internet really don’t show you how the surgery is done–so be prepared for a few bloody pictures–STOP SCROLLING if you are squeamish!

 

This is at the beginning of a repair for a cystocele—all the brown stuff you are seeing on the skin is the antiseptic povidine scrub used to reduce infection.   There’s a little blood.

We start by making an incision (cut), in the vagina on the front/upper wall–side of the bladder– the vagina and the bladder?  For a rectocele–we do the same thing along the back wall.

You can literally see the scissor blades through the skin—THE RECTUM IS JUST UNDER THE SCISSORS!  This woman had a grade 2-3 rectum prolapse–it was sticking out of her vagina just at rest without pushing–and she was young enough that sex is still an issue.  This prolapse wasn’t stopping her from having sex–but it WAS rubbing on her underwear and getting chafed.  She wished to have it surgically corrected.

This next picture shows the bladder ( I am using the front and back end interchangeably here just to show you how thin the tissues are–same principle for back and front end repair), exposed.   It is the bulge you see.  Most of the bulge has been freed up from the back of the vagina but at about 4 o clock you can see where the bladder is still attached and has to be freed.  The point here is that you see how thin the skin is, and how close the bladder is—this is why your surgeon tells you that getting into the bladder can happen with surgery, and that would have to be repaired.

 

 

I am pointing at the bladder bulge with the scissors.  Can you see at lower right where the bladder is still “stuck”, and has to be freed up?

 

 

 

This next picture shows that the bladder has been reinforced and now you can’t see the bulge.  We pull in tissue from the sides towards the middle, so it is not so thin anymore, and the bulge is gone.   When we do this on the rectum side it takes that little “cul-de-sac” away and you have a straight shute for your poop–so to speak..

Next–we cut off the loose saggy skin and then sew up a nice straight seam instead of the balloon sleeve you had!

The same is done for the bladder and the rectum–just picture this all being done with the bulge at the top or the bottom!   Same thing happens–you cut away the vagina from a bladder/rectum bulge, pull the tissues in from the side to reinforce the bladder/rectum ,and then cut away the saggy skin, and sew a nice new seam–so to speak.

 

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