Vaginal vault suspension is a surgery performed to fix a vaginal wall prolapse. The surgery repairs the structures that support the vaginal vault in such a way that its anatomical position is readjusted as much as possible.
Who needs vaginal vault suspension?
Based on its increasing order of severity, doctors grade a vaginal prolapse. The grades range from grade 0 to grade 4. Initially, mild to moderate forms will be first treated with conservative options that include pelvic floor exercises and the use of vaginal pessaries.
A mild vaginal vault prolapse may not cause symptoms. As it progresses, it can cause
- Feeling of heaviness in the vagina
- Lower back pain
- Problems with bladder or bowel control
- Dyspareunia (painful intercourse)
- Pelvic pain
- Bleeding ulcers over the bulge
Women with a severe form of vaginal vault prolapse and severe symptoms will generally need vaginal vault suspension surgery.
What causes vaginal vault prolapse?
The vaginal vault is a part of the vaginal canal. It is supported by ligaments and other structures that are attached to the uterus. Vaginal vault prolapse is caused by the weakening of these ligaments and pelvic floor muscles.
The factors that put women at a greater risk for vaginal vault prolapse include:
- Prior hysterectomy
- Four or more vaginal deliveries
- Menopause
- Advancing age
- Chronic obstructive pulmonary disease (COPD)
- Chronic constipation
- Heavy lifting
What is done before vaginal vault suspension?
If you are on medications, your doctor will instruct you what medications you can continue and what should be stopped for a few days before the surgery.
You will usually be admitted to the hospital a night before the surgery. You will not be allowed to eat or drink anything after midnight except for a few sips of water (4 hours before the surgery).
How is vaginal vault suspension performed?
A vaginal vault suspension is done by reattaching the prolapsed vaginal vault to the higher portions of the ligaments (attached to the uterus) with permanent stitches or through a synthetic mesh (a loosely woven sheet).
After administering the anesthesia to numb your pelvic region, the surgery can be performed via any of the two approaches:
Vaginal approach: The instruments for performing the surgery will be inserted by dilating (opening) the vagina.
Abdominal approach: This is again of two subtypes.
- Laparotomy: A single, large cut of about 6-12 inches will be made in the lower abdomen along the bikini line.
- Laparoscopy: Several smaller cuts will be made to carry out the surgery. A long tube-like camera will be inserted to visualize the vagina and the surrounding structures. Other tools are inserted through other cuts and the procedure is carried out.
The surgeon will decide the type of procedure for a patient depending on
- The patient's age
- Any other existing disease
- Previous surgery
- The level of physical and sexual activity
QUESTION
The vagina includes the labia, clitoris, and uterus. See AnswerWhat happens after vaginal vault suspension?
Depending on your overall condition, you will be shifted to the intensive care unit or the general ward.
Usually, the patient is discharged within 1-3 days of the surgery. In the case of laparotomy, it will take longer (3-7 days).
How long does it take to recover from vaginal vault suspension?
You can resume your regular but light household activities immediately after you get discharged.
You will need to avoid any strenuous activities for at least 6 weeks after the surgery. Such as:
- Situps
- Heavy workouts (that put pressure on your abdomen or pelvic region)
- Heavy lifting (over 5 pounds) for at least 6 weeks after surgery
Ask your doctor when you can resume sex after the surgery.
Follow up is generally scheduled 6 weeks after the surgery when the surgeon checks whether the wound has healed completely.
You will be instructed to follow up again, which is 3 months after you have returned to your normal activities. At this time, the doctor will evaluate how successful the surgery has been by asking you a few questions and examining the vaginal area.
What are the complications of vaginal vault suspension?
Every surgery carries a few risks. Vaginal vault suspension is no exception to this. The complications depend on the type of surgery.
Your surgeon will discuss all the benefits and risks with you before the operation. Make sure to clear any queries that you may have.
The possible risks with vaginal vault suspension surgery include:
- Internal bleeding
- Surgical wound infection
- Injury to bladder, ureters, or bowel
- Recurrent urinary tract infections
- Vaginal discharge
- Dyspareunia
Coolen AWM, et al. The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis. Int Urogynecol J. 2017;28(12):1767-1783
Uzoma A, Farag KA. Vaginal vault prolapse. Obstet Gynecol Int. 2009;2009:275621
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