As part of your prolapse approach, you may have been advised or chosen to have surgery. This short blog covers:
- different types of surgery
- how to prepare for surgery
- the benefit of pelvic floor muscle training pre-surgery
- movement prehab (and rehab)
- lifestyle factors
DISCLAIMER: The information in this blog is not medical advice and does not cover the pro’s and cons of surgery. If you feel that surgery is your best option, please speak with your GP and ask for a referral. A pelvic health physio may also refer you.
Types of prolapse surgery
Surgery for prolapse may include a hysterectomy. Whilst this is sometimes the case (and that is totally dependent on the individual), the uterus actually plays a supportive role for the pelvic organs.
Anterior or posterior colporrhaphy: For anterior or posterior vaginal wall prolapse – the prolapsed vaginal wall is reinforced with sutures. Mesh is sometimes used to reinforce the repair.
Sacrohysteropexy: For uterine prolapse – mesh is attached to cervix and secured to the sacrum
Sacrocolpopexy: For vaginal vault prolapse after hysterectomy – mesh is attached to vaginal wall and secured to the sacrum
Colpopcleisis: Partial or complete closure of the vaginal opening with sutures.
Types of surgery taken from PopUpPro course
Does surgery for prolapse work?
This is a particularly loaded question as surgery may be done for many different reasons! There is not consistent data on the success or failure of prolapse surgery. With estimates ranging from 0-92% failure rate and a reoperation rate of around 10%
It’s success will be down to many reasons (feels like a blog for another time!).
Preparing for Prolapse surgery
Studies have shown a benefit of topical eostrogen 6 weeks prior for bladder or uterine prolapse. For those using eostrogen, they experienced increased thickness of the vaginal wall as well as better production of collagen. These can help retain the sutures post op and improve the quality of the pelvic floor tissues.
Pelvic Floor strengthening
The pelvic floor muscles sit at the base of your body and are responsible for:
- supporting the pelvic organs
- creating a closing force for the bladder and back passage and therefore preventing leaks
- relaxing when delivering a baby
- relaxing when passing urine or faeces
A pelvic floor muscle training (PFMT) programme may be recommended prior to surgery to improve strength and function of the pelvic floor muscles. Plus knowledge around how to perform “the knack” and helpful habits for bowel and bladder (see section below on bowel and bladder habits).
Building strength and stabilisation pre-op is a great way to help support recovery post op.
This may include:
- how to coordinate the abdominals with the pelvic floor
- how to breathe when performing a particular movement e.g. getting out of a chair, getting up off the toilet
- Improving core stabilisation by strengthening the glutes, hips and core which helps take the pressure off the pelvic floor
- Improving full body strength
PS it’s probably not a time to hit the gym hard or sign up for bootcamp but work on gentle progressive overload and gentle cardiovascular exercise before your prolapse operation.
Understanding intra-abdominal pressure (IAP)
What is IAP and why does it matter pre or post surgery?
Intra-abdominal pressure is created when we move, breathe, lift etc. It’s not that IAP is inherently bad, it’s just we want to make sure that increases in IAP can be managed by the pelvic floor/core. Too much IAP (done repeatedly and consistently on a pelvic floor that is perhaps weak or lacking the necessary function) may increase symptoms. Understanding what IAP is pre-surgery can be useful to build awareness of daily activities that increase IAP. Post-surgery when the body is healing and the pelvic floor is particularly vulnerable is not the time for lots of extra IAP!
Movements to consider post surgery:
- lifting particularly from the floor
- getting out of bed
- going from sitting to standing
- breath holding (eg in the presence of pain)
Bowel and bladder habits
Improving and managing bowel and bladder habits are a useful part of prehab or rehab and may include:
– looking at positioning for bladder and bowel movements
– addressing constipation (positioning, nutrition and hydration, abdominal massage)
– bladder retraining looking at frequency and duration of passing urine
This blog has explored the types of prolapse surgery as well as useful tips for prehab and rehab. If you would like to improve your strength, core, and pelvic floor function in anticipation of surgery, you can book a 15-minute call here. Working together we can make sure you go into surgery feeling strong and well equipped for your recovery.