At Northwestern Medicine, our Women's Health specialists* strive to recommend the least invasive course of treatment for your pelvic health condition. Often, medications, therapy and nonsurgical procedures will correct your problem. In some cases, however, surgery may be your best option.

Surgical procedures

Depending upon your unique condition, Northwestern Medicine physicians may recommend a minimally invasive or traditional open surgical procedure to reduce your pelvic pain, or urinary or fecal incontinence, including:

• Abdomino-sacrocolpopexy: This procedure repairs vaginal prolapse by anchoring the top of the vagina to the sacrum, the part of the spinal column directly connected to your pelvis. It can be done traditionally, through an open, larger incision in the bikini area, or using laparoscopic or minimally invasive techniques, through tiny incisions with robotic assistance.
• Anal sphincteroplasty: Surgeons perform anal sphincteroplasty to repair torn anal sphincter muscles, often resulting from a difficult vaginal delivery or previous anal surgery. The injured muscle is identified, and the repair is made by strengthening the muscle and tightening the sphincter.
• Colpocleisis: This procedure is a last resort to treat pelvic prolapse and is only performed if you are no longer sexually active. During the surgery, physicians close your vaginal opening by sewing the front and back walls of the vagina together, which eliminates the majority of the vaginal canal.
• Cystocele and rectocele repair: Cystocele repair reduces vaginal bulge to help correct bladder prolapse. Rectocele repair is used to treat rectum or large bowel prolapse. Both of these procedures can be performed vaginally.
• Mid-urethral slings: Mid-urethral slings are surgically placed to provide support to the bladder neck and urethra. They are often an appropriate and effective treatment for stress urinary incontinence.
• Rectopexy: In this procedure, your rectum is restored to its normal position, so that it no longer protrudes through your anus. Rectopexy corrects rectal prolapse and can be done at the same time as partial colon resections and/or sacrocolpopexies.
• Sacral nerve stimulation: If other treatment options have failed, sacral nerve stimulation is a minimally invasive procedure, in which a thin wire is connected to a neurostimulator (similar to a pacemaker) to deliver therapies that can treat a wide range of pelvic floor disorders. This new treatment was previously used only for overactive bladder and urge urinary incontinence, but recent FDA approval has led to its application for fecal incontinence. The sacral nerves travel from the spinal cord to pelvic muscles. They regulate both sensation and strength of rectal and anal sphincter muscles. Thin wires are inserted into the muscles of the lower bowel, then stimulated by means of an external pulse generator to determine which muscle or muscles stimulate anal contractions the most. Once a successful response is found, a permanent pulse generator may be implanted. This treatment is typically done if other treatments have not worked. A tibial nerve stimulator is another device for urinary incontinence, which uses an electrode placed beneath the skin to deliver electrical pulses to the tibial nerve in your ankle. The pulses then travel to your sacral nerve, helping to control overactive bladder.
• Transanal rectal prolapse repair: Transanal rectal prolapse repair is performed through your anal opening. Although it is less invasive than a rectopexy, the success rates may not be as favorable.
• Treatment of hemorrhoids, rectocele or rectal prolapse: If fecal incontinence is occurring from another condition, surgical correction of these conditions may reduce or eliminate the problem.
• Vaginal hysterectomy, laparoscopic hysterectomy or oophorectomy: In a hysterectomy, your uterus and cervix are removed. During a minimally invasive vaginal hysterectomy, surgeons remove your uterus and cervix through your vagina. Laparoscopic hysterectomy is another form of minimally invasive hysterectomy and can be done in conjunction with laparoscopic pelvic reconstruction for repair of prolapse. An oophorectomy is the surgical removal of the ovaries. Physicians sometimes remove the ovaries while performing a hysterectomy.
• Vaginal vault suspension: These procedures are performed through your vagina and treat pelvic prolapse by re-suspending your dropped vagina to strong ligaments in your pelvis. It can be an excellent alternative to traditional abdominal surgery.

da Vinci® Surgical System

Depending upon your condition, Northwestern Medicine physicians may use the da Vinci® Surgical System for your minimally invasive procedure. This advanced surgical tool gives them far greater precision, vision and control. With only a few small incisions, you recover faster and may realize:

• Less pain
• Lower risk of infection or complications
• Reduced blood loss
• A shorter hospital stay
• Faster return to normal activities
• Less scarring