Posterior vaginal wall prolapse

The classical posterior vaginal repair involves not only plication of the fascia underlying the vaginal skin but also a central plication of the fascia overlying the pubo-coccygeus muscle even including the muscle itself. There can be little doubt that inclusion of the pubococcygeus fascia and muscle will create a more solid repair with accompanying intra- and post-operative morbidity but it is unclear whether the functional outcome is better. Kahn and Stanton [10] performed a 2-year follow-up of their posterior vaginal repairs performed in the conventional manner (including levator plication). They noted that in addition to one in four of the women having posterior prolapse on examination more women volunteered functional problems with respect to bowel and dyspareunia than pre-operatively. Some have suggested that a transanal approach to rectocoele repair should be more effective for treatment of defaecation difficulty but the limited robust literature available does not support this [11]. Although the site-specific fascial defect repair has been found to be more effective by some surgeons [12] it has not been studied in a robust, systematic manner.

Similarly, there have been few studies reported to assess the value of adding support materials to a posterior vaginal wall repair. The risk of mesh erosion must be weighed against the potential benefit of reduced risk of recurrence.

Perineal descent is commonly seen with posterior vaginal wall prolapse. Its clinical relevance is not clear but in anatomical terms it indicates either that the perineum is no longer supported by the pelvic floor or that there is weakness of the pelvic floor as a whole. This may be an

Posterior Wall Prolapse

index of the support of the vaginal vault or the uterus and vaginal apex.

Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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