Pelvic Reconstruction

Pelvic reconstruction surgery is comprised of several procedures that repair pelvic floor problems in women, primarily pelvic organ prolapse.

What Are Pelvic Floor Disorders?

The pelvic floor in women is a sling-shaped group of muscles that support the pelvic organs including the bladder, urethra, uterus, vagina and rectum. The pelvic floor is important for internal organ support, bladder and bowel control and sexual function.

The pelvic floor can be weakened by repetitive or excess strain on the muscles, such as frequent heavy lifting, obesity, chronic constipation, pregnancy and childbirth, as well as the hormonal changes associated with menopause and simply growing older.

A weakened pelvic floor can cause one or more organs to move downward out of position. This condition is called pelvic organ prolapse. There are several types of POP depending on which organ has been displaced, including:

  • Anterior prolapse (cystocele): The most common type of pelvic organ prolapse, in which the bladder drops down and pushes against the wall of the vagina.
  • Posterior vaginal prolapse (rectocele): The front wall of the rectum sags and bulges into the vagina. 
  • Small bowel prolapse (enterocele): The small intestine bulges into the vagina.
  • Uterine prolapse: The uterus drops down into the vagina.
  • Vaginal vault prolapse: The upper part of the vagina weakens and sags into the vaginal canal.

Signs and Symptoms of Pelvic Floor Disorders

Pelvic floor disorders can cause a variety of symptoms, including:

  • aching, pressure or feeling of fullness in the pelvis
  • constipation or straining during bowel movements
  • feeling or seeing tissue protruding from the vagina
  • frequent urge to urinate
  • painful urination
  • urinary and bowel incontinence, a leaking of urine or feces

Types of Pelvic Reconstruction Surgery

The goal of pelvic reconstruction surgery is to restore the original arrangement of the pelvic organs and maintain them in their proper positions. There are several types of reconstructive surgery, including:

  • Colporrhaphy, also called vaginal wall repair, is used to treat anterior and posterior vaginal prolapse. In this procedure, stitches are placed to strengthen the vagina and provide support for the bladder or rectum.
  • Native tissue repair, or uterosacral ligament suspension or sacrospinous fixation, is used to treat uterine or vaginal vault prolapse. In this procedure, a prolapsed organ is surgically attached to a ligament or muscle in the pelvis. This surgery may be performed together with a procedure to prevent urinary incontinence.
  • Sacrocolpopexy is used to treat vaginal vault prolapse and small bowel prolapse. Surgical mesh is attached to the walls of the vagina and then attached to the tailbone, which lifts the vagina into place.
  • Sacrohysteropexy is used to treat uterine prolapse. Surgical mesh is attached to the cervix, the tube of tissue that connects the vagina and uterus, and then to the sacrum, a part of the spine near the tailbone, which lifts the uterus back into place.
  • Vaginally placed mesh is used to treat all types of POP in women whose own tissues are not strong enough for native tissue repair. Because this technique presents a significant risk of severe complications, such as bladder or bowel damage, pain, infection and mesh erosion, it is usually reserved for cases where the benefits outweigh the risks.

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