Q. I am a 65-year-old woman and a mother of two grown-up sons.
After giving birth to my second son about 30 years ago, I had a prolapse and had an operation to fix it. However, the prolapse is now more serious. Sometimes, it even blocks the urine from coming out.
I have seen a doctor who advised that I should have my womb removed as I have had my menopause, and will no longer be able to conceive.
Otherwise, she suggested that a rubber ring be inserted. This means that I have to visit the hospital to replace the ring frequently.
I am quite worried about removing my womb as it may be a major operation. Should I go ahead with the operation?
A. The surgery which you had after the birth of your second son was most probably a Manchester surgery, which conserves the womb, and is performed through the vagina. In this surgery, a part of the cervix (neck of the womb) is removed and the supports of the womb are tightened, thereby pulling up the womb.
There are other procedures which can help to conserve the womb, including sacrospinous hysteropexy which attaches the womb to a strong ligament structure in the buttock. This is also performed through a vaginal approach.
Sacrohysteropexy is another surgical procedure which uses synthetic slings to pull up the womb, and is performed through a cut in the abdomen or through a keyhole approach.
For some women, the supports of the womb get weaker and the prolapse may recur after they have menopause and are suffering from a chronic cough or constipation.
You may feel that something is blocking your urine from coming out because of the prolapse of the bladder and urine passage through the front wall of the vagina. The degree of prolapse needs to be assessed by a gynaecologist.
A prolapse is the protrusion of an organ beyond its normal position. The protrusion of the uterus along the axis of the vagina, or out of it, is called an utero-vaginal prolapse. The most common form of prolapse in women is of the bladder and the urethra, which is a protrusion of the anterior vaginal wall.
Other types of prolapse include a protrusion of the rectum from the posterior vaginal wall.
You can choose between conservative management and surgery. Conservative management involves fitting a ring pessary which needs to be changed in the clinic every six months. A pessary is a device worn in the vagina to support a displaced uterus, and regular pelvic examinations are needed.
During an examination, the pessary is removed and the vagina cleansed and checked for any skin erosions or ulcers due to pressure effects. If no skin lesions are noted, the pessary is changed and another review will be scheduled.
Some side effects of using a pessary include vaginal discharge, and long-term usage may cause vaginal wall ulceration.
The more effective surgical option is vaginal hysterectomy and pelvic floor repair - which is the removal of the womb through the vagina and the pushing up of the prolapsed bladder and rectum with stitches.
It is major surgery which takes about one to two hours and requires about two days of hospitalisation. But the pain is much less and recovery is faster, compared to open surgery through the abdomen.
Removing the womb is recommended after menopause, especially if you have a prolapse.
As with any form of surgery, removal of the womb is not without its risks. Some possible complications or side effects include blood clots, wound infection, bleeding after surgery, urinary tract injury or problems relating to the use of anaesthesia during surgery.
However, these side effects are usually transient, and the risks involved are very low.
It is a non-functional organ and there is an increased risk of prolapse recurrence if it is conserved.
Associate Professor Han How Chuan
Head and senior consultant in the department of urogynaecology at KK Women's and Children's Hospital
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