Pelvic Floor Reconstruction
What are Pelvic Floor Problems?
The pelvic floor is formed by muscle and connective tissue overlaying the pelvic bones. They support the pelvic organs such as the bladder, uterus and vagina, and rectum. With ageing and childbirth, some of the support tissues weaken or tear, which can give rise to symptoms such as urinary leakage, vagina and uterine prolapse, and also vaginal laxity and loss of tone.
“A pelvic organ prolapse occurs when the muscles are unable to hold the organs in place and they drop downwards into the vagina.”
How to Know if You have Pelvic Floor Problems?
Pelvic floor disorders affect up to 25% of women aged 30 – 70 globally. Depending on the severity, pelvic floor dysfunction can present a variety of symptoms:
- Urinary incontinence (loss of bladder control or urine leakage when coughing, sneezing or exerting yourself)
- Bulge or sensation of heaviness in the vaginal area
- Pelvic pressure
- Pain during sex
- Lower back pain
How are Pelvic Floor Disorders Treated?
Treatment for pelvic floor dysfunction and uterine prolapse includes:
- Lifestyle management such as exercises to strengthen the pelvic muscle
- Inserting a pessary to support the prolapsed tissue
- Removal of the uterus (hysterectomy) for severe prolapse cases
- Laparoscopic/ Robotic pelvic floor reconstruction
What is Laparoscopic/ Robotic Pelvic Floor Reconstruction?
This is the use of keyhole surgery to repair and strengthen the support for the pelvic organs. There are different ways of performing the reconstruction procedure:
1. Laparoscopic/ Robotic Burch Colposuspension
This is used to treat urinary stress incontinence. Burch colposuspension was the gold standard in the treatment of urinary stress incontinence.
Sutures are used to support the bladder neck, which has the added effect of lifting the para-vaginal tissues. This procedure is suitable for most patients and for those who prefer not to use the mid-urethral tape.
2. Laparoscopic / Robotic Sacrocolpopexy
This is used to treat severe vagina prolapse. Often the patient might have had a hysterectomy (removal of the womb) done earlier, but there is a loss of support for the vagina and it prolapses.
The vagina is lifted and pulled back into position and anchors are created (with the use of mesh) so that it stays in place.
3. Laparoscopic / Robotic Uterosacral Suspension
This is used to treat a milder form of vaginal prolapse. Some patients may feel a lump at the vulva / perineal area, which might be due to uterine descent. The procedure makes use of your body’s own tissues and ligaments to provide support and lift the uterus back into the pelvis.
A/Prof Fong has been performing laparoscopic pelvic floor reconstruction for many years. He is one of the few surgeons in the region who is able to perform such procedures, and has been teaching his younger colleagues for such procedures.