Surgery Overview
Two common forms of pelvic organ prolapse are bladder prolapse (cystocele) and urethral prolapse (urethrocele). A cystocele occurs when the wall of the bladder presses against and moves the wall of the vagina. A urethrocele occurs when the tissues surrounding the urethra sag downward into the vagina. Both conditions are easy for your doctor to see during a physical examination. They often occur at the same time and are usually caused by damage that happens when a baby is delivered through the mother's birth canal (vagina).
While many women have some degree of bladder and urethral prolapse, few ever have any symptoms. Or the symptoms do not appear for years. When symptoms do appear, they may include difficulty urinating, involuntary release of urine (urinary incontinence), and pain during sexual intercourse. Surgery is not required unless your symptoms interfere with daily activities.
Unless another health problem is present that would require an abdominal incision, the bladder and urethra are usually repaired through an incision in the wall of the vagina. This surgery pulls together the loose or torn tissue in the area of prolapse in the bladder or urethra and strengthens the wall of the vagina. This prevents prolapse from recurring.
There are several types of surgery to correct stress urinary incontinence. These surgeries lift the urethra and/or bladder into their normal position. To learn more about these surgical procedures, see the topic Urinary Incontinence in Women.
What To Expect After Surgery
General anesthesia usually is used during repair of the bladder and urethra. You may stay in the hospital from 1 to 2 days. You may go home with a catheter in place. You can most likely return to your normal activities in about 6 weeks. Avoid strenuous activity, such as heavy lifting or long periods of standing, for the first 3 months, and increase your activity level gradually. Straining or lifting after you have resumed normal activities may cause the problem to recur.
Most women are able to resume sexual intercourse in less than 6 weeks. Urinary function usually returns to normal in 2 to 6 weeks.
Why It Is Done
Repair of the bladder and urethra is done to manage symptoms such as pressure on the vaginal wall from the movement of those organs, difficulty urinating, urinary incontinence, and painful intercourse. If you are experiencing involuntary release of urine (urinary incontinence), further testing may be needed to find out what procedure is needed.
Bladder and urethral prolapse often occur with the prolapse of other pelvic organs, so tell your doctor about any other symptoms you have. If your doctor finds a uterine prolapse, rectocele, or small bowel prolapse (enterocele) during your routine pelvic examination, that problem can also be repaired during surgery.
How Well It Works
Not much is known about how well the surgery works over time. Some experts report that up to 20 out of 100 women have another prolapse (recurrence) of the bladder or urethra after surgery.footnote 1
Risks
Risks of cystocele and urethrocele repair include:
- Urinary incontinence.
- Urinary retention.
- Painful intercourse.
- Infection.
- Bladder injury.
- Formation of an abnormal connection or opening between two organs (fistula).
What To Think About
Pelvic organ prolapse is often caused or made worse by labour and vaginal delivery, so you may want to delay surgical repair until you have finished having children.
Surgical repair may relieve some, but not all, of the problems caused by a cystocele or urethrocele. If pelvic pain, low back pain, or pain with intercourse is present before surgery, the pain may still occur after surgery. Symptoms of urinary incontinence or retention may return or get worse following surgery.
You can control many of the activities that may have contributed to your cystocele or urethrocele or made it worse. After surgery:
- Avoid smoking.
- Stay at a healthy weight for your height.
- Avoid constipation.
- Avoid activities that put strain on the lower pelvic muscles, such as heavy lifting or long periods of standing.
References
Citations
-
Lentz GM (2012). Anatomic defects of the abdominal wall and pelvic floor. In GM Lentz et al., eds., Comprehensive Gynecology, 6th ed., pp. 453–474. Philadelphia: Mosby Elsevier.
Credits
Current as of:
July 17, 2020
Author: Healthwise Staff
Medical Review:
Sarah Marshall MD - Family Medicine
Anne C. Poinier MD - Internal Medicine
Martin J. Gabica MD - Family Medicine
Kathleen Romito MD - Family Medicine
Femi Olatunbosun MB, FRCSC - Obstetrics and Gynecology
