Medical Edge Newspaper Column

Surgery One Option For Repairing Prolapsed Bladder

Sept. 11, 2006
DEAR MAYO CLINIC:
I'm 80 years old and have a prolapsed bladder. I'm using a pessary, but I'd like to have my bladder repaired instead. What is the least invasive option? -- East Meadow, N.Y.

ANSWER:
Even at an advanced age, women can do well with surgical repairs for a prolapsed bladder. A prolapsed bladder, where the bladder protrudes down into or out of the vagina, is common as women age. It occurs when pelvic floor supportive tissues weaken due to various factors including vaginal childbirth, chronic straining and the effects of aging. Symptoms include a feeling of vaginal pressure or heaviness, urine leakage or difficulty passing your urine, and a bulge of tissue at the vaginal opening.

Using a pessary, a supportive device inserted into the vagina, is one way to improve symptoms. The pessary is taken out regularly, cleaned and then reinserted. Most women can do this themselves. While a pessary is the least invasive treatment option, it's not for everyone. Surgery is also an option. An estimated one in 11 women will have this type of surgery in her lifetime.

The least-invasive surgery is performed through the vagina. Several surgical procedures can be used to support the bladder and other areas that may be affected. Often, when the bladder is affected, so are the uterus, rectum and other areas in the vagina.

Vaginal pelvic-floor repair procedures are commonly done on women of all ages. It would be the preferred approach in your situation. Repairs via an abdominal route are effective for specific types of vaginal prolapse, but this surgery typically has a longer recovery time.

These are some issues to consider: You need to be able to tolerate surgery. Your health care provider will want to review your medical history and current medications, perform a physical examination and order appropriate medical tests prior to considering surgery. If everything is OK, you would meet with a surgeon (gynecologist, urogynecologist or urologist) to discuss the specific procedure(s) and an anesthesiologist to discuss the type of anesthesia (regional vs. general) that is best for you.

Having surgery of any sort involves taking a risk. By preparing ahead of time and having appropriate care before, during and after your surgery, you will minimize your risks.

-- John B. Gebhart, M.D., Director, Urogynecology Incontinence and Pelvic Organ Prolapse Clinic, Mayo Clinic, Rochester, Minn.