What should I do if the anterior vaginal wall sags? Severe cases should be treated surgically

Anterior vaginal wall prolapse may be accompanied by urethral prolapse and cystocele, especially cystocele, which is very common. Surgical and non-surgical treatments are available for anterior vaginal wall prolapse. Surgery is suitable for severe anterior vaginal wall prolapse, and vaginal wall repair is the most common.

1. Non-surgical treatment

1. Surgical treatment, pessary: ​​An ancient treatment method suitable for different degrees of vaginal prolapse. A pessary with a diameter larger than the transverse diameter of the urogenital hiatus can support the uterus and vaginal walls and keep it in the vagina without falling out. It is made of silicone rubber, plastic, etc. and comes in many shapes, the most commonly used ones are ring-shaped, trumpet-shaped, or spherical pessaries.

Choose a pessary of appropriate size. The first time you use a pessary, it should be placed under the guidance of a physician. Use it during the day, take it out at night, wash it and set it aside. If left unremoved for long periods of time, the pessary may become incarcerated and may even cause urinary fistula or fecal fistula. It is not suitable for patients with cervical and vaginal wall inflammation, genital tract ulcers, and severe prolapse that cannot be reduced. It should be discontinued during menstruation and pregnancy, and reviewed every 3 months after use.

2. Pelvic floor muscle (levator ani muscle) exercise: suitable for people with mild vaginal prolapse. Instruct the patient to perform anal contraction exercises, forcefully contracting and relaxing the pelvic floor muscles for 10 to 15 minutes each time, 2 to 3 times a day. This therapy can be performed in conjunction with taking the traditional Chinese medicine Bu Zhong Yi Qi Tang.

3. Improve overall condition: Treat and eliminate chronic diseases that increase abdominal pressure, such as cough and constipation. Postmenopausal women should take appropriate estrogen supplements to avoid excessive fatigue and rest to improve and reduce the degree of vaginal prolapse.

2. Surgical treatment

Surgical treatment is used for patients with prolapse of grade II or above, patients with symptoms of rectocele, and patients who have not responded to conservative treatment. The principle of surgery is to restore the normal anatomical position of the uterus or remove the uterus, repair excess mucosa of the vaginal wall, and suture and repair the pelvic floor muscles. The following commonly used surgical methods can be selected according to the patient's age, fertility requirements, and overall health status.

1. Surgery to strengthen pelvic fascia support: Suitable for patients with grade I or grade II prolapse accompanied by bulging of the anterior and posterior vaginal walls and those with elongated cervix. Common surgeries include:

⑴ Anterior and posterior vaginal wall repair;

⑵ Repair of the anterior and posterior vaginal walls + partial cervical resection and shortening of the main ligament;

⑶Ligament suspension surgery. Laparoscopic shortening of the round ligament and sacroiliac ligament is suitable for patients with congenital simple mild vaginal prolapse.

2. Total vaginal hysterectomy and anterior and posterior vaginal wall repair: suitable for patients with grade II and III prolapse who have no fertility requirements.

3. Vaginal closure: also known as Le-Fort surgery. It is suitable for patients without malignant changes in the cervix, the elderly who cannot tolerate major surgery and who lose their sexual intercourse function due to partial vaginal closure after surgery.