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Everyone Needs Manual Hands-On Therapy After a Hysterectomy to Treat Adhesions

Everyone Needs Rehab After Incontinence or Prolapse Surgery to Avoid Another Surgery

After surgery we have two objectives:

  1. Heal from the adhesions and disturbances of the surgery
  2. Optimize strengthen, ergonomics, and function to prevent future surgeries

Much of surgery for prolapse and incontinence is just a way of delaying more problems.

How Long Do I Need to Wait for Manual Hands-On Therapy After My Surgery?

You need to wait a minimum of eight weeks, or until your doctor releases you to resume normal activities.

What Kind of Manual Hands-On Therapy and Rehab Exercise Will I Need After Prolapse/Incontinence Surgery and Hysterectomy?

After a hysterectomy or prolapse/incontinence surgery you will need 10-20 hours of manual hands-on therapy to treat adhesions. We will be careful to not disturb mesh or other implants.

You need to provide Dr. Caroline Peterson with your hospital discharge summary of your surgery so she can understand what was done.

The manual hands-on treatment will include work on the tummy and inside the pelvic bowl.

Because most prolapse and incontinence surgeries do not provide permanent relief, we take this opportunity to strengthen and normalize the supporting structures so your body will become less reliant on mesh and other supports.

You will need approximately 2-3 hours of exercise instruction, including instruction in proper physiologic breathing, and 20-30 minutes of daily home practice of these exercises.

1-2 hours of daily walking is encouraged. Start where you are and work up to longer walks.

We are designed to walk and walk and walk. We are animals. You must build your pelvic girdle to prevent future prolapse and problems.

Adequate nutritional intake including protein and fat is necessary for building the support system that you need for the pelvic organs. We will spend about 1 hour discussing diet and nutrition.

The Following Sections Are Meant to Remind You of The Type of Surgery You Had so You Have a Good Understanding of What Was Involved

What Types of Hysterectomies Are There?

Your surgeon and you will decide the type of hysterectomy that is right for you and your willingness to take risks.

If it is possible to leave at least one ovary, your body will benefit.

  • Partial Hysterectomy
    • Removal of the body of the uterus
  • Total Hysterectomy
    • Removal of the body of the uterus and the cervix
  • Hysterectomy with Oopherectomy (or salpingo oopherectomy)
    • Removal of the body of the uterus, the cervix, the ovaries, and perhaps the fallopian tubes
  • Radical Hysterectomy
    • Removal of the body of the uterus, the cervix, and part of the vagina

How is a Hysterectomy Performed?

There are several ways hysterectomies are performed.

If you are considering a hysterectomy, your doctor would select the approach that is best for you and your condition.

Types of Hysterectomies

  • Abdominal Hysterectomy
    • A 6-8 inch incision is made horizontally or vertically in your lower tummy
    • If you have fibroids or need to have the ovaries and fallopian tubes also removed, this could be the chosen surgery
    • If you have disseminated endometriosis, this could be the type of surgery suggested
  • Vaginal Hysterectomy
    • If you have prolapse, your surgeon could recommend removal of the uterus through the vagina
  • Laproscopic Hysterectomy
    • A laproscopic hysterectomy is a type of vaginal hysterectomy that is camera guided
    • Incisions will be made in your tummy and air will be blown into your tummy, then a camera will be introduced
    • The uterus will be removed in sections through the vagina

 

What is Uterus Prolapse Surgery?

For women who do not want a hysterectomy, there are several surgical options for uterine prolapse.

However, in general after uterine prolapse surgery 23% of women will have their uterus fall down again within two years.

  • Sacrohysteropexy is the most common surgery for uterine prolapse
  • This laproscopic surgery is done under general anaesthesia.
  • Small incisions are cut in your abdomen and air is blown into the abdomen (as with all laproscopic surgeries) so organs and tissues can be visualized with a small camera and surgical instruments are inserted inside you
  • Surgical mesh is sewn into the front and back of the cervix and the uterus is lifted up out of the vagina.
  • The mesh is sutured into a ligament on the sacrum
  • Fibers from the ligament will grow into the mesh and continue to support the uterus
  • This surgery can also be used if you had a hysterectomy and the cervix is left and begins to drop down into the vagina

What are the surgeries & procedures for stress incontinence?

  • Colposuspension (colpo = cervix in Greek & vagina in Latin)
    • A cut is made in the lower tummy and the neck of the bladder is lifted and the vagina is also lifted up and sewn around the pubic bone to stabilize the bladder
    • This surgery can be open or laproscopic. Both require general anaesthesia
    • The surgery has about 50-70% success
    • The downside is women may have difficulty emptying the bladder, be more prone to infection, and experience discomfort with sex
  • Sling Surgery
    • A cut is made in your lower tummy and your vagina
    • A piece of your rectus abdominus or thigh fascia (or tissue from another person or an animal or synthetic mesh) is removed to be used as the sling
    • The tissue or mesh (called “tape”)  is looped under the urethra like a hammock and stitched in place to hold it up
    • If you have the mesh sling, it is an outpatient procedure and you can go home the same day (this is preferred in the US)
    • If you have the traditional surgery using your tissue or someone else’s you will have to stay in the hospital for a couple days
    • If you get the mesh sling, about 5% of people respond to the mesh or experience mesh erosion, which is painful
    • After the surgery women may experience overactive bladder, difficulty peeing, incontinence, and urinary tract infections

What is Bladder Prolapse (Cystocele) Surgery?

Bladder prolapse (cystocele) surgery is for people who have severe prolapse (stage III – bladder protruding out of the vagina or IV – all the pelvic organs protruding out of the vagina) or bothersome symptoms with moderate prolapse (stage II – bladder slides down to the entrance of the vagina) that have not responded to kegels, pessary, and pelvic floor therapy.

In general, after bladder prolapse (AKA anterior wall) surgery 38% of women will have their bladder fall down again within three years.

There are two categories of bladder prolapse (cystocele) surgery

  • Obliterative Surgery
    • Obliterative Surgery involves closing the vagina enough to hold in the pelvic organs.
      • After this surgery you will not be able to have vaginal sex
  • Reconstructive Surgery
    • Anterior Colporrhaphy (Anterior Wall Repair) is the most common surgery for bladder prolapse
      • General anaesthesia or spinal block is used for this surgery
      • The surgeon will cut a line in the front wall of the vagina
      • The bladder will be lifted up out of the vagina and the urethra also will be lifted out of the vagina
      • Stitches will be put in the tissue between your vagina and bladder to strengthen the anterior wall and hold up the bladder
      • Sometimes a patch will be positioned between your bladder and vagina to give more support. The patch is made out of a cadaver.
      • The sides of the vagina will be sewn to the walls of the pelvis
      • It is difficult to determine the long term success of this procedure since many of the studies are comparing variants of this study, including different stages of prolapse, including surgeries for multiple types of prolapse. Many studies only report subjective improvement several months out rather than long term.
      • In a meta-analysis, the quality of these studies was determined to be low to moderate, so it is difficult to draw solid conclusions about long term effectiveness.
    • Colposuspension
      • Colposuspension can be done in addition to anterior colporrhapy, or instead of colporrhapy
      • A cut is made in the lower tummy and the neck of the bladder is lifted and the vagina is also lifted up and sewn around the pubic bone to stabilize the bladder
      • This surgery can be open or laproscopic. Both require general anaesthesia
      • The surgery has about 50-70% success
      • The downside is women may have difficulty emptying the bladder, be more prone to infection, and experience discomfort with sex

What is Rectal Prolapse (Rectocele) Surgery?

There are two types of rectal prolapse (rectocele) surgery.

In general, 38% of women will have their rectum fall down again within three years of having posterior wall surgery.

  • Obliterative Surgery
    • Obliterative Surgery involves closing the vagina enough to hold in the pelvic organs.
      • After this surgery you will not be able to have vaginal sex
  • Reconstructive Surgery
    • Posterior colporrhapy is the most common reconstructive surgery for the rectocele (rectal prolapse).
    • An incision is made in the posterior wall of the vagina and weak muscle fibers are identified that are responsible for allowing the rectum to move forward into the vagina.
    • Stitches are placed to support those weak muscles
    • Usually a surgery is done on the perineal body (between the vagina and the anus) at the same time to offer more support to the posterior vaginal wall. This surgery is called perineorrhaphy.
    • A meta-analysis of the  posterior colporrhaphy is reported published studies are of low to moderate quality and difficult to draw conclusions from.

What is Vaginal Vault Prolapse Surgery?

Sacrocolpopexy is the name of vaginal vault prolapse surgery.

If the upper part of the vagina falls into the vagina and the vagina begins turning inside out, you are experiencing vaginal vault prolapse.

Commonly the other pelvic organs will follow prolapsing.

Most sacrocolpopexy is done laproscopically under general anesthesia as an out patient surgery

  • Four or five incisions will be cut in your abdomen through which the camera and instruments will be introduced
  • Air will be blown into your abdomen to inflate it
  • Surgical mesh will be attached to the top and bottom of the vagina and then fixed to the sacrum on the back wall of the pelvis
  • This will suspend your vagina back into place
  • If you have any organ that has prolapsed, your surgeon will place support for them also
  • If you have incontinence, the surgeon will place mesh under the urethra
  • Your surgeon will check to be sure no holes were accidentally made in the organs, then take out the instruments and close your incisions.

You will need about eight weeks to heal from this surgery