Pelvic surgery -Types , Symptoms, and Diagnosis

Pelvic surgery is a broad term that clubs the surgeries performed in the pelvic area. The gynaecological surgeries are primarily performed in the pelvic area.  

Pelvic organs like the uterus, bladder or rectum when drop down from the original position, the condition is called pelvic organ prolapse.

The inability to hold urine results in involuntary urination. This condition may be caused due to the weakness of pelvic muscles. This is usually caused due to stretching during childbirth.

Apart from these conditions, pelvic surgery is performed for other diseases and conditions like obesity and chronic pulmonary disorders.

People affected with pelvic disorders have various symptoms. However, patients with mild pelvic disorders are usually asymptomatic.

Initially, people with pelvic disorders experience severe pain or discomfort in the pelvic area. They describe it as the feeling of fullness in the vagina. These symptoms improve when they are lying down.

Patients affected with severe pelvic disorders can see their pelvic organs protruding through their genitals. They are first treated with lifestyle modification, including weight loss.  

Exercise for your pelvic and bladder can have some benefits. Other severe symptoms should be treated with surgery if the medical management fails. As per the NCBI research paper titled “defining Success After Surgery for Pelvic Organ Prolapse”, the success rate of pelvic surgeries ranges from 76–97.2%.

Types of pelvic surgery

Symphysis pubis dislocation

The pubic symphysis is placed between your pelvic bone and right pelvic bone. The weight of your upper body is absorbed by pubic symphysis before travelling to your lower body.

The dislocation of the symphysis pubis is a rare type of lateral compression injury. The symphysis pubis displaces against the contra-lateral intact pubic body.

The surgery is performed in cases of unstable pelvic ring injuries. The surgery involves stabilising the pubic symphysis using plates and screws. The symphysis pubis dislocation is associated with posterior injuries.  

Pubic ramus fracture

A pubic ramus is a group of bones supporting the pelvis’s upper portion. A break in one of these bones can lead to a fracture.

These types of fractures occur in high-energy trauma. Most pubic ramus fractures will heal on their own and will not require surgery.

It takes about 7–8 weeks to recover from the fracture. However, the healing of the fracture depends on the severity.

Patients affected with fractures pubic ramus may experience leg and groin pain. The symptoms differ from one person to another. Your doctor will give you tablets to alleviate the pain.

Walking is suggested for this type of fracture. Walking will help to improve blood circulation and hastens healing process.

Iliac fracture

The iliac bone is commonly considered the weak bone in the posterior portion of the body, and fracture occurs in this region.

The pelvis holds the pubis, ischium and ilium bones together with a tough ligament which forms a girdle of bones.

The fractures that occur in the iliac are considered high energy and are often unstable. They progress from the iliac crest to the sciatic notch.

The treatment depends on the fracture and the severity of the fracture. The treatment can sometimes be non-operative, but surgery should be performed in severe conditions to restore movement.

Sacroiliac joint dislocation

Sacroiliac joint dislocation is a high-energy injury. The treatment for a sacroiliac joint fracture is considered complex.

Fixation after percutaneous reduction are the standard treatment which has shown promising results. It also depends on the severity of the dislocation.

The reduction treatment can be a challenging task. The sacroiliac joint is a multi-axial bone, and the fracture in the sacroiliac joint can be complex.

These injuries can be treated with 2D fluoroscopy assisted with image intra-operatively. 3D fluoroscopic systems, CT scans and navigated have been used since the early stage.

Sacral fracture

The fracture that occurs on the sacrum is called a sacral fracture. The sacrum makes up a part of the pelvis and a wedge-shaped bone.  

It helps to transmit the weight of the body to the pelvic girdle. The fracture in the sacral happens when the bone becomes insufficient to handle the stress of the body’s weight.

As a result, the bone loses its strength and supporting structure, and becomes weak. This may be usually caused due to a condition called osteoporosis.

Symptoms of sacral insufficiency include pain in the hip, buttock or groin. If there is a fracture in the pubic ramus, it can cause pain in the front pelvis region. Walking can be a painful event.

Nerve damage during sacral insufficiency or fracture is rare. When there is nerve damage, it can lead to issues associated with bladder or bowel movement and decreased strength and sensation of the legs.

Obliterative surgery

Obliterative surgery is performed to correct the pelvic organ prolapse. Obliterative surgery is usually suggested for women who cannot take up any extensive surgery.

The obliterative surgery cannot be performed for women who will indulge in sexual intercourse in future. As people age, the sexual needs decreases. So obliterative surgery is usually recommended for old aged people.

Reconstructive surgery

Reconstructive surgery is usually performed to repair the organ affected during an injury. Reconstructive surgery will aim to restore the organs in their original procedure.

The pelvic organs include the uterus, vagina, rectum, bladder and urethra. These organs are held together with the pelvic muscle.

Pelvic organ prolapse occurs when there is damage to the tissue and muscle, they no longer can hold the organ in place.

The reconstructive surgery is performed for such pelvic organ prolapse. Reconstructive surgery is one of the common options for women who cannot take up big procedures like extensive surgery.

The reconstructive surgery is also done through an incision in the vagina or the abdomen. Sometimes laparoscopy is suggested.

Symptoms

The symptoms of pelvic organ prolapse differ from one person to another. Some people might experience severe symptoms—others may be asymptomatic.

The symptoms of pelvic organ prolapse are listed below.

The feeling of pelvic pressure or fullness

The pressure in the pelvic bone leads to instability of the strength. This makes your pelvic organs drop, and you will have a feeling of fullness in your vagina.

A bulge in the vagina

A weakness in the pelvic bone becomes unstable for the bone to hold the organs. As a result, the uterus drops down to your vagina, and causing a bulge.

Other symptoms like constipation, lower-back pain, urine leakage and bulge in the vagina are also seen.

Organs bulging out of the vagina

The organs that drop down due to pelvic organ prolapse bulge out of the vagina.  

Leakage of urine (urinary incontinence)

The prolapse in the uterine can occur when the muscle and tissues weaken. As a result, the pelvic bone cannot hold the pelvic organ together. The uterus drops down to your vagina.

This weakness in the muscles and tissues leads to leakage of urine.  

Difficulty completely emptying the bladder

When you have a pelvic organ prolapse, you will face problems like difficulty emptying the bladder. This might be caused due to childbirth, pregnancy, heavy lifting and menopause. This will cause you to urinate often.

Problems with bowel movement

When there is a pelvic organ prolapse, you will experience a strain in bowel movement. You will also not be able to empty your bowel fully.

Lower back pain

Lower back pain is a common symptom when you have pelvic organ prolapse. The pain differs from one person to another depending on their condition. If people have severe prolapse, they might experience pain which can be unbearable. Some people may be asymptomatic of such pain.

Problems with inserting tampons or applicators

People experience discomfort when they have pelvic organ prolapse. They might feel discomfort while inserting a tampon. The uterus may drop down, and there will be a feeling of fullness in your vagina.  

Diagnosis

The diagnosis of pelvic organ prolapse involves examining the different parts of the pelvic organ. The diagnosis also depends on the severity of the symptoms.

X-rays show the disruptions (fractures and/or dislocations)

The X-ray in the pelvic organ will help the doctor to identify deformities in the pelvic organs, hip or upper legs.

The X-ray will also help the doctor to find the reason for swelling and pain. The bone fracture is usually identifiable with an X-ray.

X-rays are usually the simplest and quickest method to detect any fracture in the bone. Sometimes, they can be difficult to analyse due to the complexity of the organ shapes.

Surface electrode

The surface electrode is used to determine the strength of the pelvic muscle. They are placed on the skin and are self-adhesive. Surface electrode diagnosis is used when the internal examination is not an option.

The electrodes are placed between the vagina and rectum for women, and for men, it is placed between the rectum and testicles.  

The surface electrode is not a painful examination like the other internal diagnostic methods.

Anorectal manometry

Anorectal manometry is a diagnostic method to measure the efficiency of the rectum and anal sphincter. These muscles are essential for proper bowel movement.

The anorectal manometry diagnosis is usually performed for patients who experience symptoms like constipation and faecal inconsistency.

The rectum and anal sphincter work together to eliminate the faeces. If you have a pelvic fracture or prolapse, you will have difficulty excreting stools out of the body.

Defecating proctogram

The defecating proctogram is a diagnostic method to determine the movement of the muscles. A thick liquid is given, which acts as an enema.

A video is recorded of the muscle, how well the muscles can excrete the enema out of the rectum and the muscle movement.

Uroflow test

The uroflow diagnostic method tests the flow of the urine. If you can urinate and empty your bladder at a stretch, it implies that the pelvic floor functions well.

If you have to stop and restart again, it signifies dysfunction in your pelvic floor, like the surface electrode uroflow test is not painful.

Risk factor  

Bleeding

Bleeding can be a life-threatening risk factor in pelvic bone fracture. They might cause internal bleeding, which can be uncontrollable. The bleeding might result in thigh, pelvic or retroperitoneal haemorrhage.

Infection

Infection or inflammation of the pelvic floor is a common risk factor. The fractured bones can damage the internal organs. This might cause internal bleeding and infection.

Adjacent Tissue  

The infection can spread to adjacent tissues and organs.

Organ Injury

When the pelvic bones lose their ability to hold the organs in place, it might cause the pelvic organs to drop down. These misplacements of organs can cause injury, and they might cause dysfunction.

Vesicovaginal fistula

The abnormal opening that forms between the wall of the vagina and bladder is called a vesicovaginal fistula. These openings can be treated with surgery.

Urinary retention

Urinary retention is a condition where you cannot fully empty your bladder. There are two types of urine retention—acute and chronic.

An acute condition is when you suddenly cannot urinate, and a chronic condition where the ability gradually increases.

Conversion to open surgery

When the symptoms are severe, surgery is the only option.

Hernia

When the pelvic bones weaken, they might lose the ability to hold the organs. As a result, the organs can herniate.

Conclusion

Pelvic organ prolapse can occur in aged women. The condition can be corrected with surgery, but it affects the quality of life and causes discomfort.

To avoid such discomforts, maintain a healthy weight and remember to work out daily. This will help to improve your muscle strength and prevent muscle weakness.

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