Native-tissue repair, also called fixation or suspension, is surgery to treat uterine or vaginal vault prolapse without the use of mesh. The reconstructive surgery is done through an incision in the vagina. The surgeon uses stitches to attach the prolapsed part to a ligament or muscle in the pelvis. Vaginal surgery with native tissue repair may be used to repair prolapse of the cervix, bladder, small bowel, uterus, or rectum. The procedure may be done in combination with a hysterectomy if the patient has a prolapsed uterus. A procedure to prevent urinary incontinence may also be done.
Symptoms of Vaginal Vault Prolapse
Vaginal prolapse occurs when the top of the vagina weakens and falls into the vaginal canal. In severe cases, the top of the vagina may bulge through the vaginal opening. Women may experience the following symptoms:
- Vaginal fullness
- Feeling that something is falling out of the vagina
- Changes in bowel and bladder function, such as difficulty passing urine or stool
- Pain or discomfort during sexual intercourse
- Difficulty using tampons
- Secondary prolapse, such as rectocele or cystocele
Symptoms of Uterine Prolapse
Uterine prolapse occurs when stretched or weakened pelvic floor muscles are no longer able to support the uterus, causing it to slip down into or protrude through the vagina.
Women with uterine prolapse may experience the following symptoms:
- Seeing or feeling tissue bulge out of the vagina
- Feeling as if they’re sitting on a small ball
- Sexual concerns, such as feeling as though the vaginal tissue is loose
- Feeling heaviness or pulling in the pelvis
- Inability to completely empty the bladder
- Pressure or discomfort in the pelvis or low back
- Urinary incontinence
- Difficult having a bowel movement and needing to press the vagina with your fingers to help have a bowel movement
- Feeling as if they have vaginal tissue rubbing on clothing
Factors To Consider Before Undergoing Surgery
Before making the decision to undergo native-tissue prolapse repair surgery, patients should consider the following factors:
- Their age. Younger patients face a risk of prolapse that returns in the future and requires additional treatment. Older patients with a history of surgeries may be limited in the type of surgery they may have.
- Childbearing plans. Patients who would like to have more children after surgery should consider postponing the operation until their family is complete. This will reduce the risk of future prolapse.
- Health conditions. Patients with heart disease, diabetes, breathing problems, or a smoking habit may be at increased risk.
Patients should speak to their primary care physician to determine whether surgery is a good option for them. After surgery, some patients may experience pain during sexual intercourse, urinary incontinence, and pelvic pain.
The Recovery Process
Patients will need a few weeks to recover from the procedure. After surgery, patients should:
- Avoid strenuous exercise, lifting, and straining for the first few weeks
- Avoid sex for several weeks
- Maintain a healthy weight
- Avoid constipation by eating a healthy diet