Mesh Grafting for Pelvic Floor Reconstruction

When an organ becomes displaced or slips down in the body, it is referred to as a prolapse. Women affected by pelvic prolapse often refer to their “dropped bladder”or “fallen uterus”. In the medical profession, these conditions are referred to in more technical terms–such as “cystocele”,”uterine prolapse”, or “rectocele”.

Symptoms of pelvic prolapse can include pressure or discomfort in the vaginal or pelvic area, often made worse with physical activities such as prolonged standing, jogging, or bicycling. For othe women, diminished comfort and control in the bladder and/or the bowels can be an indicator of a worsening prolapse condition.

Cystocele: The Bulging Bladder… is often referred to as a dropped bladder. A cystocele forms when the normally flat upper vaginal wall loses its support and sinks downward. The allows the bladder, which is located right above the upper vaginal wall, to drop right along with it. When a cystocele becomes advanced, the bulge may become visible outside the vaginal opening. The visible tissue is the weakened vaginal wall; the bladder is right behind the skin but cannot be seen. The symptoms causes by cystoceles can include vaginal bulging or pressure, slowing of the urinary stream, overactive bladder symptoms, and an inability to fully empty the bladder.

Rectocele: The Bulging Rectum… is formed when the normally flat lower vaginal wall loses its support, allowing the rectum to bulge upward. This creates an extra pouch in the normally straight rectal tube. Rectoceles cause symptoms related to incomplete emptying of the rectum. Even a minor rectocele bulge may cause difficulty with bowel movements–including the need to strain more forcefully, a feeling of rectal fullness even after a bowel movement, including fecal soiling, and in some cases incontinence of stool or gas. Those symptoms result from stool and air remaining within the rectocele pouch even after defecation, in contrast to the normal rectum, which fully empties. Larger rectoceles can bulge right through the vaginal opening and look like a cystocele, although in this case it is the lower vaginal wall accounting for the bulge.

Enterocele: The Female Hernia… occurs when intestines bulge downward into the top of the vagina. Enteroceles are similar to hernias that can develop in the abdominal and groin areas of both women and men: both involve bulging of the intestines into weakened supports nearby. In a man, hernias bulge through the abedominal wall; in a woman; enteroceles bulge into the top of the vagina. The symptoms can be vague, including a bearing down pressure in the pelvis and vagina, and perhaps a lower backache. This can exist alongside vaginal vault prolapse in women who have had a hysterectomy.

Uterine Prolapse: The Fallen Uterus… is a weakening of the support structures at the top of the vagina (called the vault or apex). When this happens, the apex sinks downward toward the vaginal opening. This allows the uterus, which is located right above the vaginal apex, to drop right along with it. When the uterine prolapse becomes advanced the bulge may become visible outside the vaginal opening. The visible tissue is the weakened vaginal wall; the uterus is right behind the skin but cannot be seen. The symptoms caused by uterine prolapse include, but are not limited to, vaginal pressure, vaginal pain, pain during intercourse, recurrent bladder infections, and difficulty with urination.

Vaginal Vault Prolapse… is a weakening of the support structures at the top of the vagina (called the vault or apex), in women who previously have had a hysterectomy. During the hysterectomy procedure, the apex was likely attached to supportive ligaments on either side of the pelvis. These attachments prevent the top of the vagina from bulging outward beneath the constant pressure of the abdominal contents. However if these attachments weaken and the vaginal apex drops, a bulge may form near the vaginal opening. This causes vaginal vault prolapse, a condition that only happens to women who have had a hysterectomy., and one that can cause severe pressure and bulging symptoms.

Pelvic prolapse repairs can be performed in a few basic ways:

• through vaginal incisions,
• through traditional abdominal incision, or
• through a laparoscopic approach.

Hospitalization and recovery times vary for each procedure type.

Surgical repairs for prolapse sometimes involve the placement of “mesh” or “graft” materials, to reinforce areas of weakened tissues. Mesh based transvaginal surgeries are indicated for tissue reinforcement and stabilization of fascial structures of the pelvic floor in vaginal wall prolapse. Treatment using this method can be very effective in some patients.

If you are considering pelvic floor reconstruction surgery, your physician will ask you questions about your medical history, to ensure you are a candidate for this type of procedure. Consult your physician for a complete understanding of this information and to determine whether this procedure is right for you.