What is an anterior prolapse?

An anterior prolapse is a bulge of your vagina caused by your bladder dropping down. It is caused by weakness of the support tissues between your vagina and bladder.

What are the benefits of surgery?

The aim is to tighten the support tissues of your bladder and remove the bulge in your vagina.

Are there any alternatives?

If you have a mild prolapse, your doctor will usually only suggest that you have an anterior repair after you have tried simple treatments. These include the following:

• pelvic floor exercises – this is the most effective non-surgical treatment.
• placing a pessary – this involves placing a device inside your vagina to support the tissues.
• vaginal estrogen cream – this helps lubricate and strengthen the vagina.

Alternatively, you can choose to have no treatment and monitor your symptoms.

If the prolapse is large and you do not plan on having sex again, an option is to close your vagina.

What will happen if I decide not to have the procedure or the procedure is delayed?

A prolapse can seriously affect your quality of life but is not life-threatening. A prolapse may slowly get larger, eventually appearing at the entrance of your vagina.

If you have only a mild prolapse, your doctor may be able to recommend an alternative treatment for you.

If you experience any of the following symptoms, contact your healthcare team.

• Changes to your monthly bleeding pattern if you have periods.
• Increased abdominal (tummy) swelling.
• Worsening pain that needs more medication than you are currently taking.

What does the procedure involve?

The procedure is usually performed under a general anaesthetic but various anaesthetic techniques are possible. The procedure usually takes about 30 minutes.

Your doctor will examine your vagina. They will make a cut on the front (anterior) wall of your vagina so they can push your bladder and urethra (tube that carries urine from your bladder) back into place. Your doctor will stitch the support tissues together to provide better support for your bladder and urethra. They will cut away a small part of your vaginal wall to remove tissue left over from the repair.

How can I prepare myself for the procedure?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the procedure, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team are trained to reduce the risk of complications.

Possible complications of this procedure are shown below. Some can be serious and may even cause death.

Any risk rates given are taken from studies of people who have had this procedure. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, you are obese, you smoke or you have other health problems. Health problems include diabetes, heart disease or lung disease.

General complications of any procedure

• Feeling or being sick.
• Infection of the surgical wound.
• Allergic reaction to the equipment, materials or medication.
• Bleeding — if you have heavy bleeding you may need a blood transfusion or another procedure.
• Venous thromboembolism (VTE) — this is a blood clot in your leg (deep-vein thrombosis - DVT) or one that has moved to your lung (pulmonary embolus).
• Chest infection — your risk is lower if you have stopped smoking and you are free of Covid-19 symptoms for at least 7 weeks before the procedure.

Specific complications of this procedure

• Incontinence, when urine leaks from your bladder.
• Urine infection — his is one of the most common complications and usually makes you want to pass urine more often.
• Difficulty passing urine, if your bladder gets swollen or bruised, or if the muscles around your bladder do not contract well enough.
• Developing a collection of blood (haematoma) between your vagina and your bladder. If the haematoma is large and causing symptoms such as pain and difficulty passing urine, your doctor may need to drain it under an anaesthetic. Sometimes a haematoma will drain through your vagina, usually causing bleeding similar to a period for up to 6 weeks. If a haematoma becomes infected, you may need another procedure.
• Damage to your bladder and ureters (tubes that carry urine from your kidneys to your bladder). Your doctor will usually notice any damage and repair it during the procedure. However, damage may not be obvious and this can cause an abnormal connection to develop between your bladder and vagina, causing you to leak urine. You will need another procedure.
• Recurrent prolapse — this is when the same prolapse happens again. You will need another procedure.
• New prolapse — this is when another prolapse happens in a different part of your vagina. You will need another procedure.
• Painful sex following surgery. This usually gets better with time. Some women experience ongoing pain with sex following surgery but this is rare.

Consequences of this procedure

• Pain.

What happens after the procedure?

You are expected to go home the same day. However, if you have a drip, pack or catheter in place, you may need to stay overnight.

Rest for 2 weeks and continue to do the exercises that you were shown in hospital.

Do not have sex, use tampons, or go in the bath, swimming pool or hot tub for at least 6 weeks and not until heavy bleeding and discharge have stopped.

Do not stand for too long or lift anything heavy. You can return to work once your doctor has said you are well enough to do so (usually after 6 to 8 weeks). You should be feeling more or less back to normal after 3 months.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Continue your pelvic-floor exercises as soon as possible and keep doing them for life.

Summary

An anterior repair is an procedure usually recommended after simpler treatments have failed. Your bladder should be better supported and you should no longer have a bulge in your vagina.

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