Female Pelvic Medicine and Reconstructive Surgery
Consultation and thorough management are provided in situations involving complex benign pelvic conditions, lower urinary tract abnormalities, and pelvic floor dysfunction by female pelvic medicine and reconstructive surgery. The diagnostic and therapeutic treatments required for the patient's complete care are included in comprehensive management, together with these conditions, any complications they may cause, and other relevant factors. (1)
Definition and Overview
The vagina, uterus, bladder, urethra, and rectum are among the pelvic organs. The muscles of the pelvic floor support these organs in their position. Connective tissue layers also provide support. Treatment for pelvic floor conditions including incontinence, vaginal prolapse, and pain is covered by FPMRS. Specialists in this field help women at various stages of life. In addition to aging, injuries, menopause, and nervous disorders, childbirth can weaken the pelvic floor muscles and lead to incontinence.
When they cough, sneeze, or laugh, many women leak urine. They frequently think that this comes with getting older. However, age is not always a factor or a guarantee in the development of urinary incontinence and other pelvic floor disorders. Depression and other issues can occasionally result from losing bladder control. (2)
If a person has symptoms of pelvic conditions and they are affecting normal activities, that person may need treatment. Non-surgical treatment options are usually tried first. If these options do not work and the symptoms are severe, surgery may be considered. Here are most of the common pelvic conditions:
- Incontinence (leakage of urine)
- Overactive bladder (urination too frequently, in the middle of the night, or having to rush to the bathroom)
- Problems with bladder emptying
- Neurologic disorders of the bladder
- Bladder pain issues
- Dysuria, or painful urination
- Recurring bladder or urinary tract infection
- Hematuria, or blood in the urine
Pelvic Organ Prolapse
- Cystocele, fallen bladder
- Rectocele, fallen rectum, also called fallen or dropped bladder, uterus, vagina, and rectum
- uterine prolapse, fallen womb, or uterus
- Painful bladder syndrome or Interstitial cystitis
- Vulvodynia/vaginal pain
- Painful intercourse
- Rectal pain
- Fecal Incontinence, or leakage of stool
Birth Injury and Trauma
- Postpartum healing issues
- Pelvic injuries
- Injuries to the vagina or rectum from childbirth
- Healing or pain issues after childbirth
Abnormalities of the Vagina, Bladder, or Urethra
- Congenital Malformation
- Cysts or masses in the vagina, pelvic floor, or urinary tract (3)
For these conditions, specialists can use non-surgical procedures and/or surgical procedures. These can be listed as:
- Non-surgical procedures
Pelvic floor therapy: Manual therapy to help strengthen or replace the pelvic floor.
Botox bladder injections: A muscle relaxant used for urinary incontinence.
Pelvic floor biofeedback: Muscle retraining to help patients learn to strengthen or relax their pelvic floor muscles.
Urethral bulking agents: Injections that can help treat female urinary incontinence.
Pelvic floor electrical stimulation: Electrical stimulations for weak pelvic floor muscles.
- Surgical procedures
Mid-urethral sling: Provides support under the urethra to prevent it from falling during physical activity.
Uterosacral ligament suspension: An operation to restore support to the uterus or vagina.
Sacrospinous fixation: An additional operation to restore support to the uterus or vagina.
Burch urethropexy: A surgical procedure with support to the urethra.
Mesh removal: Removal of the vaginal mesh that was previously placed to treat pelvic organ prolapse or incontinence.
Pubovaginal sling: A procedure used to manage urinary incontinence.
Anterior and/or posterior repairs: including repairs of both the vagina and bladder
Fistula repairs: Vaginal fistula repairs.
Abdominal sacrocolpopexy: Surgery to correct the muscles, ligaments, and tissues that support the vagina.
Congenital anomaly repairs: including repairs of many congenital pelvic floor anomalies
Ureteral stents: A thin tube placed in the ureter to help block the flow of urine. (4,5)
In general, women experience many pelvic conditions, and each of them can have different symptoms. Patients who experience the following most common symptoms may be good candidates for pelvic treatment or surgeries.
- a localized pain in the hip or groin area
- spasms or cramps
- painful or difficult urination
- pain involving the entire abdomen
- pain aggravated by movement or during the examination
- pain during intercourse
- sudden onset of pain
- slowly-developing pain (6)
Risks and Side Effects
- Damage to the intestines and complications from adhesions.
Less pain may be experienced during sexual activity following surgery with an abdominal incision than after treatments through the vagina. However, there is a chance of intestine damage and complications from adhesions with abdominal incisions.
- Erudition of surgical mesh into the vagina
There is a slight possibility that the abdominal mesh after surgery will erode (wear through the tissues into the vagina). Mesh erosion may result in permanent scars and pain. To remove the mesh, additional surgery might be required.
Patients should seek full details from medical professionals regarding the risks, advantages, and potential problems of any treatment involving vaginally inserted mesh. In numerous cases, pelvic conditions can be successfully treated without mesh. Surgery performed through the vagina may be quicker to complete than surgery performed through an abdominal incision. Usually, recuperation takes less time. (7)
Post-Procedure and Follow-up
There are many types of treatment and surgery, depending on the patient's health status and the severity of the disease. Their follow-up and recovery processes may differ from each other. The patient needs to talk with the doctor about the content of the surgeries and treatment in depth. At the follow-up visit, the doctor advises when it is appropriate to resume exercise and sexual activity.
Recovery time varies depending on the type of surgery or procedure. If the patient is working, he usually needs to take a few weeks off from work. It is generally recommended to eat light meals first after procedures and surgeries. In cases of constipation, the doctor may prescribe a stool softener. In addition, sexual intercourse should be avoided for a few weeks after the operation.
Showering is fine while you are recovering, but bathing is not allowed after vaginal surgery. There may be some vaginal bleeding or spotting. In this case, no tampons or showers are used. Daily activities are started slowly. Walking is fine, but strenuous exercise and carrying heavy objects should be avoided. It is important to consult a doctor in case of an emergency. (8)
Operations are usually successful. The purpose of the operations is to save the patient from his ailments and to regain his health. When the treatments are completely completed, the patient continues his daily life. According to the study, treatment success varied greatly (19.2–97.2%) depending on the definition used. Approximately 71% of the participants rated their surgeries as “very successful” and 85.2% rated themselves as “much better” than before the surgery. (9)
1- Association of American Medical Colleges. Careers in Medicine. Female Pelvic Medicine and Reconstructive Surgery. (https://careersinmedicine.aamc.org/explore-options/specialty-profiles/female-pelvic-medicine-and-reconstructive-surgery)
2,8- University of Pittsburgh Schools of the Health SciencesFemale Pelvic Medicine and Reconstructive Surgery (FPMRS) (https://www.upmc.com/services/urology/services/neurourology/fpmrs#:~:text=What%20is%20Female%20Pelvic%20Medicine,in%20various%20stages%20of%20life.)
3- Women Pelvic Health Disorders. University of Illinois Hospital & Health Sciences(https://hospital.uillinois.edu/primary-and-specialty-care/pelvic-health/women-pelvic-health-disorders)
4- The University of Texas Southwestern Medical Center. Female Pelvic Medicine and Reconstructive Surgery.(https://utswmed.org/conditions-treatments/female-pelvic-medicine-and-reconstructive-surgery/)
5,6,7- American College of Obstetricians and Gynecologists. Women's Pelvic Conditions (https://www.acog.org/womens-health/faqs/surgery-for-pelvic-organ-prolapse)
9- National Library of Medicine. Defining Success After Surgery for Pelvic Organ Prolapse (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904469/#:~:text=RESULTS,much%20better%E2%80%9D%20than%20before%20surgery.)