Pelvic reconstruction may be needed after trauma or chronic disease.
The pelvic floor area in women is sometimes damaged in some way by childbirth. Pelvic structures can also be affected by age-related or postmenopausal hormone changes, and even gravity, to some extent.
If there is a need to correct urologic structures in the pelvic area, the process of achieving this goal is referred to as pelvic reconstruction.
The procedures performed related to pelvic reconstruction are collectively known as urogynecologic surgeries. This means organs and tissues related to urologic and gynecologic functions are involved. The specific structures involved will depend on the reason for pelvic reconstruction. If pelvic structures were damaged or weakened during childbirth, for instance, ligaments, muscles, nerves, and connective tissues related to the vagina, uterus, rectum, and/or bladder may be necessary.
Reasons for Pelvic Reconstruction
If pelvic structures are damaged or thrown out of alignment, women may experience urine leakage (incontinence) or urine retention. Some women might also have trouble having a bowel movement or issues with vaginal sensations. There may also be a general feeling of heaviness or discomfort in the pelvic area that affects daily life. Pelvic reconstruction may also be necessary if pelvic structures are affected by:
Trauma or injury
Issues related to pelvic surgery performed for another purpose
Performing Pelvic Reconstruction
Surgery to correct pelvic support issues may be performed through the vagina or through the abdomen. The specific approach to surgery will depend on what’s affected and what location(s) need to be accessed. Some procedures may be performed with minimally invasive laparoscopic surgery, which is performed with smaller incisions and special instruments. If multiple pelvic structures need to be accessed, traditional open surgery may be the better option. Some procedures are able to be performed with a less-invasive and more precise alternative referred to as robotic surgery.
If the space between the vaginal and rectal openings has been altered enough to affect functions, the wall in this area (recto-vaginal septum) may be reinforced with what’s called rectocele repair. A cystocele repair is sometimes necessary if the wall between the bladder and vagina also needs to be strengthened or reinforced. The area between the vaginal area and anus is sometimes cut to help with childbirth. Reconstruction sometimes involves repairing this tissue. A colporrhaphy is often performed if the front wall of the vagina needs to be corrected so that it once again supports the bladder and rectum.
If there are issues with the uterus and a woman prefers not to have a hysterectomy, a sacrohysteropexy may be done to lift the uterus back into the correct position. This type of reconstruction may involve the narrow end of the uterus (cervix) as well. Some women also need to have adjustments made with their bladder if pelvic damage extends to this structure. When repair tissue is needed, a woman’s own tissue (native tissue) may be used. If a patient’s tissue isn’t strong enough to be used for this purpose, synthetic mesh is usually used.
Results from pelvic reconstruction will depend on what structures need to be corrected. In some cases, procedures may be performed in steps to minimize stress to the body. Surgery of this nature tends to be more successful when women make an effort to avoid constipation after a pelvic restoration procedure is performed.