What Is PFR?

Pelvic floor muscles are a wide group of muscles under your pelvis that form the pelvic ‘floor’. The muscles are banded together, a bit like a hammock, to protect and hold in place your bladder, uterus and bowels. The ‘floor’ has two openings in it by which it controls, by relaxing and tightening at will, your vagina and your anus (rectum). When the ‘floor’ relaxes and contracts the openings, fluids and solids such as urine and faeces are able to leave the body.

There are two types of PFR operations;

• An anterior vaginal repair – if the front wall of your vagina has prolapsed
• A posterior vaginal repair – if the back wall of your vagina has prolapsed.

You may be having, or have had, a pelvic-floor repair operation in conjunction with a hysterectomy, if your uterus (womb) has prolapsed into your vagina.

Why is it done?

The pelvic floor can be a problem area for some women. Giving vaginal birth to several children, prolonged coughing fits, old age, obesity, a reduction in your oestrogen level resulting in weaker muscles, can together or individually lead to a weakened pelvic floor. A weakened pelvic floor can, in turn, lead to leakage of urine when one laughs, coughs or sneezes.

More seriously, if the floor is weakened sufficiently it can mean that your uterus is unsupported by it. If your uterus hangs low enough this is known as a prolapsed (or fallen) womb. Problems with a low-slung or weakened pelvic floor can lead to, for example, urine and bowel leakage, kidney infections and more.

What to expect after surgery?

The operation to repair a sagging pelvic floor can take up to 1 to 2 hour to repair. It does, however, vary from person to person.

Your gynaecologist will use dissolvable stitches. They tend to dissolve anywhere between 1 to 3 weeks. Other types of stitching can take up to nearly 7 weeks but your surgeon will decide which stitching material to use.

It can take up to 3 months to fully recover from this type of surgery. It will, however, vary from person to person. During this period, you should not lift heavy items or indulge in strenuous exercise. Activities like swimming and walking are fine.

What are the risks of the surgery?

You may experience some painful constipation and difficulty urinating, together with minor back pain for the first few days.Bleeding and infection may occur but are not very common. If a laparoscopy is used to repair the pelvic floor the chances for complications will be greatly reduced.

What are the alternatives to the surgery?

• Pelvic floor exercises or electrical implants - These may help to strengthen your pelvic floor muscles if your prolapse is minor.
• Vaginal pessary - This is a plastic ring put inside your vagina to prevent any loose vaginal skin from coming down. It can be an effective and comfortable alternative to surgery, but does not work for everyone. With regular checking it may work for many years.
• Laparoscopic surgery - This is an operation using keyhole instruments. We repair your pelvic floor through a number of small cuts in your abdomen rather than through your vagina.
• Burch colposuspension - This is an abdominal operation to lift the bladder. If your bladder has prolapsed, especially when you also have problems with leaking urine, this may be the best treatment. There is a separate leaflet within this series covering this operation.