Dr Siva has a special interest and many years of expertise in pelvic organ prolapse, including vaginal prolapse and uterine prolapse. He provides wide ranging assessment and treatment and surgery for all kinds of vaginal prolapse and pelvic organ prolapse, including surgery for recurrent vaginal wall prolapse and vaginal vault prolapse surgery.
Dr Siva also performs fertility preserving procedures for women who wish to retain their uterus (including Sacrocolpopexy and Manchester Operation), as well as providing options for conservative, non-surgical management of prolapse.
Types and causes of prolapse
Pelvic organ prolapse (POP) – also known as vaginal prolapse or prolapse – occurs when the connective tissue in your pelvic floor becomes weaker.
As the structure of your vaginal walls lose tone, one or more of the pelvic organs (the bladder, uterus, bowel and/or rectum) may slip down, causing the top of your vagina to weaken, fall into your vaginal canal and sometimes even bulge out.
Cystocele (anterior prolapse) is the most common kind of prolapse and is a prolapse of the bladder into the vagina
Vaginal vault prolapse (vault prolapse) is prolapse of the vaginal wall.
Uterine prolapse (uterovaginal prolapse) occurs when the uterus slips down into or protrudes out of the vagina.
Enterocele (small bowel prolapse) occurs when the small intestine (small bowel) descends into the lower pelvic cavity and pushes at the top part of the vagina, creating a bulge.
Rectocele (rectum prolapse or posterior prolapse) occurs when the end of the large intestine (rectum) pushes against and moves the back wall of the vagina.
Pregnancy, labour, and childbirth (especially multiple vaginal deliveries) are the most common causes of prolapse, however menopause, age, obesity, uterine fibroids, genetic factors and respiratory conditions with a chronic cough can also cause prolapse.
Symptoms and stages of pelvic organ prolapse
Symptoms of prolapse may include a feeling of a vaginal bulge, a vaginal lump, fullness or something coming down or out the vagina, lower back pain, difficulty emptying the bowel or bladder or problems with sexual intercourse.
Some women do not have any symptoms at all and only discover they have a prolapse during a routine gynaecological exam.
These are the four stages of pelvic organ prolapse:
- Stage 1: Your organs are still fairly well supported by your pelvic floor.
- Stage 2: Your pelvic floor organs have begun to fall, but are still inside your vagina.
- Stage 3: Your pelvic floor organs protrude through the opening of your vagina.
- Stage 4: Your pelvic floor organs have fallen right through your vaginal opening.
Pelvic organ prolapse surgery versus non-surgical management of prolapse
Where possible, Dr Siva will provide you with options for conservative management of prolapse, including pelvic floor exercises, seeing a pelvic floor physiotherapist or vaginal pessary insertion.
Surgery for pelvic organ prolapse/vaginal prolapse is usually only recommended if your prolapse is symptomatic.
Dr Siva will assess whether you might require surgery or whether one of the conservative management options will be sufficient to treat your prolapse.
Types of pelvic organ prolapse surgery
The right type of surgery for you will depend on your type of prolapse, the level of prolapse and your overall health and medical history.
Colporrhaphy (vaginal wall repair) – is a reconstructive surgery for patients with stage one or stage two prolapses who have not had other prolapse surgery.
Dr Siva performs this procedure through your vagina, making small incisions in your vagina before using stitches to repair or strengthen the tissue that supports the vagina. You will either have a spinal anaesthetic or a general anaesthetic for this procedure.
Hysterectomy – is usually only recommended for women with stage three or four uterine prolapse.
A hysterectomy can either be done entirely through your vagina with no cuts to your stomach, with a few small cuts to your stomach (laparoscopic or ‘keyhole’ hysterectomy) or with one long cut across your stomach (abdominal hysterectomy).
You will require a general anaesthetic and you will no longer be able to become pregnant after a hysterectomy.
Sacrocolpopexy – is a procedure where a piece of mesh is attached to your tailbone (sacrum) to give your vagina and/or uterus permanent support. It can either be performed as keyhole surgery or with one longer cut to your stomach (laparotomy) under a general anaesthetic.
Sacrocolpopexy is usually recommended for women with a stage three or stage four prolapse or for women who have already had a hysterectomy. It is also used as a uterus preserving prolapse surgery for younger women with a prolapsed uterus who don’t want to have a hysterectomy.
Colpocleisis – stitches a section of your vagina closed to prevent pelvic organs from moving into it. This operation has a very high success rate and it is performed vaginally without any incisions to your stomach.
Colpocleisis is a procedure usually reserved for older women because after this operation you can no longer have penetrative sex.
Manchester Operation – is a fertility preserving procedure which is associated with less blood loss and a faster recovery, when compared to vaginal hysterectomy.