These two weeks were unusual in that I operated on two similar cases in which both ladies were postmenopausal and suddenly presented with a lump appearing in their vagina, one after carrying extra heavy objects and the other after a bout of a persistent cough. Examination of both showed similar pathology in that their bladder had prolapsed into their vagina through a weakness in the tissues supporting the bladder wall.
This problem is quite common and very often ignored by older women who pass it off as part of ageing and think nothing of it until it either causes pain, becomes uncomfortable or the protrusion is out of the vagina and starts to rub against her underwear.
Closer examination showed that these were defects not only in the bladder wall but also of the rectum. Tears in the tissue of the bladder wall and tissues surrounding the rectum during vaginal childbirth very often contribute to this condition, and it starts to show up when the hormone levels fall as a result of menopause causing the tissues to weaken even more. The exception is the young woman in their 20's or 30's with this problem which is then caused by an inherent defect in the collagen tissues of the supporting structures of the pelvic organs.
After much discussion of the alternatives, it was decided to do a formal repair of the defects under anaesthesia. Mesh implantation was discussed with the patients but due to the incidence of long term complications with mesh it was decided to do a traditional repair of the bladder wall and a tight closure of the musculature of the pelvic floor to prevent a recurrence.
Both women have recovered well and are they will no doubt be able to continue their active lifestyles after this such as going to the gym, resuming golf and tennis and household chores.
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