Vaginal prolapse repair: options, risks and what recovery involves

Prolapse happens when the pelvic floor and its supporting tissues weaken, letting the bladder, womb or bowel bulge into the vagina. The NHS lists a feeling of heaviness or a dragging in the lower tummy, a lump at or beyond the vaginal opening, difficulty emptying the bladder or bowel, leaking on coughing and discomfort during sex. Many people have a mild prolapse with no symptoms at all and need no treatment.

Severity is graded 1 to 4, with 4 the most severe. Treatment is chosen according to symptoms, not just the grade. The NHS lists physiotherapy with a women's health specialist, weight management, treating constipation and chronic cough, vaginal oestrogen in the form of cream, tablets or a ring, and pessaries made of plastic or silicone. Surgery is generally for those who remain troubled or who do not want a device.

A trust leaflet describes the surgeon choosing between an anterior repair for a bladder prolapse, a posterior repair for a bowel prolapse, a vaginal hysterectomy for a womb prolapse, sacrospinous fixation, which anchors the top of the vagina to a ligament, and colpocleisis, which narrows or closes the vagina and is for people who no longer wish to have vaginal intercourse. Many repairs are done from inside the vagina with no cut on the tummy.

Mesh used through the vagina has been restricted on the NHS, so repairs usually rely on the person's own tissues. Ask the surgeon whether any graft is planned and why. The decision rests on which wall is affected, whether the womb is kept, your age, your health and whether you wish to remain sexually active.

Before surgery you are assessed for fitness for an anaesthetic. Some surgeons advise using vaginal oestrogen beforehand if tissues are thin after the menopause, which can help healing. Treating a cough and constipation beforehand reduces strain on the repair.

Smoking raises the risk of wound problems and a chest infection, and stopping before surgery helps. Follow your admission letter on fasting. Plan help at home and a way of avoiding lifting, including children and shopping, once you return.

• Ask whether you will wake with a catheter or a vaginal pack and for how long.

• Stock your home with stool softeners if your surgeon advises them.

• Arrange for someone to carry shopping and laundry for several weeks.

Repair is performed under general or spinal anaesthetic. The surgeon opens the vaginal wall, pushes the bulging organ back into place, strengthens the supporting layer with stitches and closes the wall. Dissolvable stitches are standard. A catheter and sometimes a vaginal pack are used for a short time.

You may go home the same day or after a night or two, depending on the operation and how you feel. Walking soon after surgery is encouraged, and you should avoid straining on the toilet.

The Plymouth leaflet lists infection, bleeding, blood clots, bladder or bowel problems and injury to a nearby organ, which it puts at around 1%. Constipation is described as very common and temporary, and difficulty passing urine at first is common.

Recurrence is the most important number for most people. The same leaflet says that approximately one in three women have prolapse come back, sometimes needing further surgery. The risk is higher with a heavy build, a chronic cough, straining or heavy lifting, so lifestyle choices after surgery really do matter. Painful sex and urinary leakage can appear or change after surgery and are worth raising before you decide.

Light vaginal discharge or bleeding can continue for six to eight weeks as stitches dissolve. The leaflet suggests four to six weeks before driving and before work, longer for physical jobs, about eight weeks before sex and about twelve weeks before strenuous sport.

Meanwhile avoid constipation and heavy lifting, and carry on pelvic floor exercises as your physiotherapist advises. Your surgeon's own instructions override these ranges, and GOV.UK says to tell the DVLA if you are still unable to drive three months after an operation.

• Fever, offensive discharge, or heavy bleeding: contact your GP, the ward or NHS 111.

• Being unable to pass urine, or severe pain.

• A swollen, hot calf, chest pain or breathlessness: call 999 if severe.

• A new bulge or heaviness in the early weeks: tell your surgical team.

• Which wall of the vagina is affected, and which operation is proposed?

• Is a pessary a reasonable alternative for me?

• Will mesh or any graft be used?

• What are my chances of recurrence given my circumstances?

• How will surgery affect sex and bladder or bowel function?

The repairs are similar in both settings, but waits for prolapse surgery on the NHS can be long and pessary care is often offered while waiting. Private surgery can be sooner, but ask about the surgeon's experience with the particular repair and what follow-up is included, because recurrence usually shows up months afterwards.