Health Q&A: a cold left leg and prolapse surgery

Dr David Roche / 24 May 2012

Dr David Roche considers a painful circulation problem and offers reassurance on surgery for a prolapse

Since Christmas, I’ve been suffering with a cold left leg from toes to upper thigh. So far, my GP has - with two blood tests - confirmed what the cold leg is not, so no treatment has been suggested though I do take nifedipine. The only time my feet are not so cold it is almost painful is when I am in bed with electric blanket. I’m nearly 90, have never smoked, eat healthily and enjoy a drink.

The most likely cause for your cold feet and particularly cold left leg is a restriction in the arterial blood supply to your feet. The circulation of blood is a little like a central heating system, with a good supply of warm blood, continually refreshed, contributing a lot to the warmth of the feet.

The arteries that carry this blood become less pliable and their diameter narrows as we age. Some of this is inevitable but the speed at which it occurs is variable. Smokers, those with high blood pressure and with high cholesterol tend to narrow their blood supply earlier rather than later. Your GP check the small pulses which can be felt in the feet , behind the knee, in the groin and in the abdomen. If any of these are missing it can indicate significant narrowing.

Techniques exist for improving the blood flow through narrowed arteries, though these are invasive and should not be undertaken lightly. Usually balloons are used to widen the narrow section and stents are then inserted to hold the artery open. There can be complications and not all arterial narrowings are suitable for this treatment. Your GP is taking a conservative approach initially, which is appropriate considering your age. Nifedipine lowers your raised blood pressure and can improve peripheral circulation. Adding in aspirin can also help by reducing the viscosity of the blood. If these strategies do not help you can be referred for a more detailed assessment of your circulation, with a view to using one of the more advanced techniques.

I am waiting for a vaginal hysterectomy due to a prolapse of my womb and I'm getting more terrified by the week. What's involved and how long will it take?

A vaginal hysterectomy is an operation to remove the uterus (womb). It is done for a variety of reasons, including prolapse which occurs when the internal support for the uterus is lost and it drops into the vagina, giving the sensation of a lump. A hysterectomy can be performed through the abdominal wall but if it can be done through the top of the vagina this is preferable. It is an everyday operation and nothing to be terrified about!

During the operation a cut is made in the top of the vagina and the uterus is separated from its attachments to the side walls of the pelvis. If these attachments are weak or stretched, as they are in a prolapse, then the surgery is easier. The uterus is removed and then the wound at the top of the vagina is stitched closed. When you wake you will have a dressing (a ‘pack’) in the vagina and a catheter to drain urine for the first 24-48 hours. The operation usually takes 60 to 90 minutes.

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