An anterior prolapse is a bulge of the vagina caused by the bladder dropping down. It is caused by weakness of the support tissues between the vagina and bladder (see figure 1).
An anterior prolapse can cause a sensation of 'something coming down', the need to pass urine more frequently and the feeling of not having fully emptied your bladder. It can also cause discomfort when having sex and difficulty keeping a tampon in.
An anterior prolapse is usually caused by childbirth. However, sometimes the problem can happen in women who have never been pregnant. Usually you only notice the problem after the menopause.
It is possible to have more than one type of prolapse at the same time – the support tissues of your womb or back passage may also be weak.
What are the benefits of an anterior repair?
The aim of surgery is to tighten the support tissues of your bladder and remove any bulge in your vagina.
Are there any alternatives to an anterior repair?
If you only have a mild prolapse, your doctor will usually recommend that you have an anterior repair only after you have tried simple treatments such as pelvic-floor exercises or inserting a pessary.
There is another surgical procedure that involves replacing the support tissues with a mesh.
What does the operation involve?
An anterior repair is usually performed under a general anaesthetic. The operation usually takes about half an hour.
Your gynaecologist will make a cut in the front (anterior) wall of your vagina so they can push your bladder and urethra back into place. Your gynaecologist will stitch the support tissues together to provide better support for your bladder and urethra. They will cut away a small part of the vaginal wall to remove tissue left over from the repair.
What complications can happen?
1 General complications of any operation
Sickness or feeling sick
Infection of the surgical site (wound)
2 Specific complications of this operation
Difficulty passing urine
Developing a haematoma
Damage to the bladder
How soon will I recover?
You should expect a slight discharge or bleeding from your vagina but you should let a member of the healthcare team know if this becomes heavy.
You will usually be able to go home after two to three days. For the first two weeks at home you should rest, relax and continue to do the exercises that you were shown in hospital.
It is best not to have sex for about six weeks or at least until any bleeding or discharge has stopped.
Avoid standing for too long and do not lift anything heavy. You can go back to work once your doctor has said you are well enough to do so (usually after six to eight weeks).
Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, you should ask a member of the healthcare team or your GP for advice.
You should continue your pelvic-floor exercises as soon as possible after the operation and keep doing them for life. This will help to prevent the prolapse coming back and reduce the risk of you becoming incontinent.
An anterior repair is a major operation usually recommended after simpler treatments have failed. If the operation is successful, your bladder will be better supported and you will no longer have a bulge in your vagina.
Paying for your procedure
Anterior repair costs are covered by most medical insurance policies, but please check with your insurer first. If you are paying for your own procedure the cost will be explained and confirmed in writing when you book the procedure. Ask the hospital for a quote beforehand, and ensure that this includes the surgeon’s fee, the anaesthetist’s fee and the hospital charge for your procedure.