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?

An anterior prolapse can cause the following problems.

• A sensation of ‘something coming down’.
• The need to pass urine more often.
• The feeling of not having fully emptied your bladder.
• Difficulty urinating.
• A bulge in your vagina, which can cause discomfort when having sex and difficulty keeping a tampon in.

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

Are there any alternatives to an anterior repair?

If you have only a mild prolapse, your doctor will usually recommend that you have an anterior repair only after you have tried simple treatments.

• pelvic-floor exercises
• placing a pessary
• vaginal estrogen cream

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

What will happen if I decide not to have the operation or the operation 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 operation involve?

The operation is usually performed under a general anaesthetic but various anaesthetic techniques are possible. The operation 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 operation?

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 operation, 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?

Some complications can be serious and can even cause death.

General complications of any operation

• feeling or being sick
• infection of the surgical site (wound)
• allergic reaction to the equipment, materials or medication
• bleeding
• venous thromboembolism
• chest infection

Specific complications of this operation

• incontinence
• urine infection
• difficulty passing urine
• developing a collection of blood (haematoma) between your vagina and your bladder
• damage to your bladder and ureters
• recurrent prolapse
• new prolapse
• painful sex following surgery

Consequences of this procedure

• pain

How soon will I recover?

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 operation 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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