Six years ago, I had an operation for a fallen bladder. Now symptoms are starting to recur. Is it likely the operation was not a permanent success?

Bladders are a recurring female problem, which often seems to worsen as one grows older.

Many difficulties occurring in later life start during childbirth, when a mother has her first or subsequent confinement.

Frequently the walls of the vagina (the birth canal) are over-stretched. If the baby happens to be particularly large the stretching may be considerable and the damage may extend to the valve of the narrow tube that leads from the bladder.

As time advances, the walls of the vagina frequently become weaker, and less elastic. Elastic fibers, also in the walls, gradually deteriorate, and the bladder starts to bulge into the vaginal canal. The valve can become weaker. As this happens, urine is left to accumulate in the bladder, and complete emptying becomes very difficult and often impossible.

This forms a reservoir for germs to breed in. Also, when any extra stress on the abdomen occurs such as in sneezing or coughing, it is common to pass urine involuntarily. This can occur at any time, often when it is most inconvenient and embarrassing.

Recurring infections in the bladder give rise to bouts of cystitis, burning, frequency, with a sense of inadequate emptying a few minutes later.

This may reach a stage when a “repair operation” is suggested by the gynecologist.

This means that a section of the loose vaginal wall is removed. The part of the bladder bulging into the vagina is stitched back and the canal is made taut once more – as it used to be before the babies put in an appearance.

The results of this operation are frequently excellent. The “stress incontinence”, and difficulty with the urine is checked almost at once, and embarrassing moments no longer take place.

As a bonus benefit, intercourse often becomes more enjoyable for both partners. The firmer canal enables a more comfortable fit during coitus, and the urinary problems (which may have reached crescendo pitch during intercourse) are no longer a worry.

However, in some women, a recurrence of the old trouble can take place. Once more the weakened, inelastic vaginal wall may recommence to bulge as time passes. Although the original repair was a success, the surgeon has little control over the nature of the tissues, their age, and the ability to produce further problems at a later stage.

Sometimes further surgery may be necessary.

After an operation of this nature, it is worth keeping in touch with the gynecologist from time to time for a check.

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