What to do if the vaginal wall bulges? It can be treated conservatively

Vaginal wall prolapse will affect the smooth discharge of urine, causing urinary retention and cystitis, and severe cases can cause urinary incontinence. It should be treated promptly. If it is mild vaginal wall prolapse, no surgical treatment is required. If it is severe vaginal wall prolapse, timely surgery is required.

1. Non-surgical treatment

Mild bulging does not require treatment. For moderate or even severe protrusion, conservative treatment can be adopted if the patient needs to have children or is elderly with serious medical diseases. Conservative treatment includes the use of a pessary, Kegel exercises, and estrogen.

2. Surgical repair method The surgical indications for the treatment of anterior vaginal wall prolapse are: ① severe prolapse; ② prolapse leading to urinary retention or recurrent cystitis; ③ accompanied by stress urinary incontinence.

(1) Anterior vaginal wall suture and suburethral plication: The purpose of anterior vaginal wall suture is to fold and suture the vaginal muscles and the fascia on the surface of the bladder (pubocervical fascia) or the vaginal side wall tissue to restore the bulging bladder and vagina to their normal positions. In many cases, regardless of whether the patient has urinary incontinence, a plication suture is placed at the vesicourethral junction to reinforce the posterior urethral support tissue to ensure that patients who do not have stress urinary incontinence at the time of surgery will not develop it after surgery. If there are symptoms of stress urinary incontinence, anti-stress urinary incontinence surgery is required.

(2) Paravaginal repair: The purpose of paravaginal defect repair for anterior vaginal wall bulging is to restore the separated vagina to the level of the arcuate ligament of the pelvic wall (ATFP) that is normally connected to it. There are two main methods: vaginal approach or retropubic approach.

(3) Surgical complications: Complications of anterior vaginal wall prolapse repair are relatively rare. Common complications include hematoma of the posterior anterior vaginal wall and damage to the urethra or bladder during separation. Repair of bladder damage often requires a urinary catheter to be placed for 7 to 14 days, which is beneficial for the healing of the bladder. Other rare complications include ureteral injury, suturing into the bladder or urethra (with related bladder symptoms), and fistula formation, such as urethrovaginal fistula and vesicovaginal fistula. If the sutures used in the repair are permanent nonabsorbable or mesh suture material, erosions, sinus tracts, and chronic granulation tissue formation in the vagina will occur. The actual incidence of these complications is unknown. Urinary tract infections are common, but other infections such as pelvic or vaginal abscesses are uncommon.

Urinary retention and difficulty emptying often occur after anterior vaginal wall repair. This situation is more common in patients with preoperative emptying dysfunction. Treatment is catheter drainage or urinary catheterization, and it takes about 6 weeks for the natural emptying function to be restored.

Some women also experience problems with their sexual life after surgery. Some women's sexual life improves after surgery, while others are affected. The former is common in patients with stress urinary incontinence, and the latter is seen in patients undergoing vaginal perineal repair.