Prolapse - another surgery option - Colpocleisis

Hi and welcome, Nina,

You can read about this surgery in my book, Saving the Whole Woman. I wish it were a cure, but it, too, has serious risks attached to it.This surgery “closes the vagina” by suturing together the muscles of the pelvic diaphragm. These muscles are part of the urinary continence system, which is often negatively effected by the procedure.

More significantly, the closure does not always hold. The “belly” or main section of a muscle does not respond well to suturing. Unlike the abdominal wall, the pelvic diaphragm does not have thick sheets of white connective tissue acting as a main feature of the wall. Re-opening of the pelvic floor and subsequent evisceration of bowel contents through the vagina is not unheard of. My book contains a case study of just such an occurrence.

It does sound plausible in theory, but when the major factor of intraabdominal pressure is included in the discussion, it is easy to understand how the dynamics of pelvic and abdominal organ support are changed when the natural rebound effect of the pelvic floor musculature is severely blunted by scar tissue and adhesions. Pressure on the pelvic diaphragm would not be met by natural expansion. Rather, the intestines would simply push against a more static wall. How long it would hold is anyone’s guess - maybe for the rest of her life, who knows.

This age-old procedure continues to be commonly offered to women. Without the context of how female anatomy actually works, women have no basis on which to make a decision.

There is no surgical cure for prolapse.

Wishing your mom well,

Christine

Dear Ms Nina:
Uterine prolapse & its associated problems can have a surgiccal solution. Dr Christine's reply is based on conventional surgical techniques of colpocleisis which, as stated by her, seem to have several limitations such as recurrence, stress incontenence, etc.
Having done over 34 cases of vaginal partitioning (instead of colpocleisis) with excellent results, I opine that it is the best available solution. So I recommend vaginal partitioning in sexually inactive, geriatric patients.
For details, please refer to my peer reviewed article on this topic in the online issue of the journnal 'Gynecological Surgery' of December 2010 of SpringerLink.
Dr.Saritha

Dear Dr Christine:
Plz refer to your reply to Ms Nina in this matter.
I request you to read my reply to her & also my Article referred to therein, which elaborates the dynamics of the surgery.
Geriatric patients are on the rise and so is the incidence of prolapse. To my mind, vaginal partitioning offers an effective and lasting solution to sexually inactive, geriatric patients. I invite your feedback.
Dr.Saritha

Hello Dr. Saritha,

I will certainly read your paper with interest and report back in the May edition of the Whole Woman Village Post. Thank you for including our readership in this subject matter.

Sincerely,

Christine Kent, RN

Hi Dr Saritha

It is good that you posted the link to your article. I have looked at it, but I am not familiar enough with anatomical terminology to understand exactly what you do in this procedure. I understood most of it, but it is not clear to me whether the septum is constructed between the sides of the vagina, or the anterior to posterior vaginal walls.

It looks to me like the anterior and posterior walls have a line cut through the vaginal lining from approximately top to bottom (because the posterior wall is longer than the anterior wall). Then then the cut edge of the right half of the anterior wall is sutured to the cut edge of the right side of posterior wall, and the same on the left, thus dividing the vaginal space into two equal halves, one on each side. Then sutures are placed right through the new septum, to keep the two surfaces of the septum from separating during healing.

Is this correct, so far?

Do all the sutures dissolve?

It is gratifying to see that your trial shows little failure in the first five years post-surgery, as opposed to Colpocleisis. Hopefully some followup can be done in the future to see if this success continues.

Sadly, it seems that followup after five years is rare in surgery world, which makes it very frustrating for women considering surgical repairs for any pelvic damage, because the woman cannot, after several attempts at repair cannot just go out and buy a new pelvic region, as she would a new car, when her 'many times repaired' car is not worth fixing again. (This statement is only partly in jest.)

In the case of this procedure I am assuming that most of these women are so old that they no longer lead active lives, and it is a matter of giving them physical comfort in their last years, so long term followup, ie 10 and 20 years hence, is not so relevant. Many of these women would be developing incontinence in very old age anyway, either because they lose the sensation of fullness, the ability to retain urine and faeces, the motivation or the mobility to get themselves to a toilet in time. For a very elderly woman who is not physically active, choice of whether or not she has surgery is a different argument.

Would you please clarify that I have understood the procedure correctly?

Nina, as Dr Saritha has appointed you as the 'watcher' of responses to her post I would appreciate it if you would be able to have her come back and answer my question, or cut and paste it into an email, and ask her for a reply, then paste her reply under this topic, for the interest of all of us.

BTW, yes Nina, this site "does not advocate woman going for surgery" because of the many subsequent problems that are commonly enough caused by surgical repair procedures, and the risk of complications and subsequent problems being very unpredictable, and potentially life changing in a negative way.

All women do not report subsequent problems by any means, but we do not know how many women experience problems but are reluctant to report them because fixing them will require more surgery, which most women are reluctant to embark on; because the research shows that the first procedure is most likely to succeed, with the success rate decreasing with subsequent surgery. In my opinion, living with the results of the first surgery can be a sensible option, even if it is worse than the initial symptoms before repair.

The other reason we are against surgery, particularly for active women, is that POP symptoms occur almost exclusively while the woman is standing and doing tasks. The surgery is done while the woman is lying on her back, and it is assessed while she is still under anaesthetic, and she is of course still recumbent. The physical arrangement of pelvic and abdominal organs is vastly different in these two diametrically opposite positions.

No wonder, when she becomes mobile again after the surgery her organs are held at unnatural angles, where the self-protective engineering of the pelvic area is unable to support the organs, thus leaving all the support function at the surgical repair site. No wonder these surgeries produce further problems, and that the site often breaks down after either a short or longer period of time.

A woman's body has pelvic engineering that has built in redundancey to ensure that she can retain her pelvic organs. If some damage or stretching happens to the endopelvic fascia which maintains the normal configuration of the pelvic organs the woman can very often retain her pelvic organs just by postural means, and by changing the way she uses her body during exercise and everyday tasks. Once she has had her uterus removed, or that engineering is disturbed by surgical repairs or other unrelated surgery, this is a lot more difficult.

Another reason we are against surgery is that unfortunately most women are not fully informed by doctors of the risks of surgical repair or hysterectomy, or do not understand the risks when they consent to it.

We want every woman to understand her pelvic anatomy very well, how it relates to the rest of her body, and to use her god-given pelvic engineering to manage these conditions, before she embarks on the one way surgical repair route, from which she cannot turn back because her body is changed forever by surgery.

We are not against pelvic repair surgery for its own sake. Pelvic repair surgery has a black history, and leaves many women worse off than they were, prior to surgery. This is not our doing. This is the doing of the gynaecologists who develop and perform the surgery. We find ourselves being guardian angels for women who are considering surgical repairs, helping them to find the best solutions for them. This role is reinforced when they find that they can manage their POPs very well without having their bodies surgically altered. some women go ahead with surgical repairs, and may or may not return to these Forums.

Frustratingly, we often enough find ourselves wiping the tears of women who have had pelvic repair surgery that has failed, or produced worse results. This further reinforces our resolve to discourage women from having surgical repairs before they have tried our methods for at least 12 months.

I think you understand why some of us spend many hours every week discouraging pelvic repair surgery, and teaching women how to use their bodies better. If we can save one woman the agony of failed surgery it is worthwhile. And I know that we have saved many more than that. They have a new approach to life, having lost the fear that stalked them previously. It is under their control. They make their own decisions.

Nina, I do hope you find the best solution to your mother's problem. You are certainly helping her very well to explore all the options available to her. I think you are a wonderful daughter to her, and you are certainly showing your own children how to look after their ageing mother one day.

One further thing to explore is that a pessary that falls out is often too small. Did she try different sizes of the ring types? I don't know if this would be the case, but it might be worth checking out, if it means that she might not have to undergo another surgery.

Louise

I happened upon this thread, and I especially wanted to bring it to the attention of newer folks on this Forum. Louise's lengthy "essay" on the mission of Whole Woman just gives me goosebumps.