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Vaginal repair surgery (colporrhaphy)

Published by Bupa's health information team, July 2008.

This factsheet is for women who are planning to have a vaginal repair, or who would like information about it.

A vaginal repair is an operation to lift up and strengthen the walls of the vagina to restore its normal support. It is also known as colporrhaphy.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About vaginal repair

Pregnancy, childbirth, obesity and menopausal changes can weaken the vaginal muscles and ligaments. As a result, organs near the vagina, such as the uterus (womb), bowel or bladder, slip down from their normal position. This is known as vaginal wall prolapse. It can lead to problems with passing urine and bowel movement, and can affect your sex life.

A vaginal repair operation helps to strengthen the vaginal walls so that nearby organs are held in position.

What are the alternatives to surgery?

Pelvic floor muscle training and mechanical devices such as a ring or shelf pessaries may help strengthen your vaginal walls. However, surgery is recommended if the prolapse is severe.

Your surgeon will discuss your options with you.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

A vaginal repair operation usually requires a hospital stay of two or three days. It is done under general anaesthesia, which means you will be asleep during the procedure.

You will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anti-clotting medicine called heparin as well as, or instead of, stockings.

About the operation

You will have a cannula (a fine plastic tube) put into a vein, usually on the back of your hand or in your arm. This causes a sharp sensation, like an injection, that passes quickly. The cannula allows your anaesthetist to give the medicines that put you to sleep and control pain and nausea, without repeated injections. You may also be put on a drip to keep you hydrated.

The operation takes about an hour and the technique used depends on the extent of the prolapse.

Typically, your surgeon makes a cut through the vaginal wall from the inside. Sometimes the cut is made in your lower abdomen, just above the pubic hairline.

The outside walls of the vagina are lifted up and attached to pelvic ligaments for support. A synthetic mesh is used to support the repair. The cut in the vaginal wall is closed using dissolvable stitches.

A urinary catheter (a thin tube) is usually put into the bladder to help drain urine into a bag. The catheter is needed because most women have difficulty passing urine immediately afterwards.

You may have dressing placed inside your vagina to minimise bleeding. This is usually removed after 24 to 48 hours.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed.

You will need pain relief as the general anaesthetic wears off. Controlling pain after an operation is very important because pain can interfere with your recovery. You may be offered patient controlled analgesia (PCA). This is a pump connected to your cannula that allows you to control how much pain medicine you have.

When you no longer need intravenous medicines and are able to drink enough fluids, the cannula and drip will be removed.

You will need to wear a sanitary towel to absorb any vaginal bleeding, which is usually similar to a light period.

The catheter is usually taken out during the first day or two. It's usual to feel some initial discomfort on passing urine but this normally improves within 24 hours. Please tell your nurse or surgeon if you have any difficulty in passing urine or problems with bladder control.

Your nurse will give you advice about getting out of bed, bathing and diet. A physiotherapist will explain some exercises that you can do to help speed up your recovery.

You may find that you don't open your bowels for a few days after the operation. However, try not to strain when you go to the toilet as this can stretch the healing wound.

Your surgeon will visit you before you go home to assess your progress and answer any questions that you have. You may be given a date for a follow-up appointment.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Recovering from vaginal repair surgery

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You shouldn't drive until you are confident that you could perform an emergency stop without discomfort. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your surgeon's advice.

It's normal to have some blood-stained vaginal discharge for about six weeks after surgery.

Use sanitary towels rather than tampons to help reduce the risk of infection.

You should take things gently for a day or two after returning home. You must not do any heavy lifting or strenuous exercise until you have made a full recovery. This can take up to three months.

Follow your surgeon's advice about getting back to your usual activities. You will usually be advised to wait at least six weeks before having sexual intercourse. You should continue to use your usual form of contraception unless advised otherwise.

If you have any of the following symptoms contact your GP as you may have developed an infection:

  • heavy bleeding with large clots
  • severe lower abdominal pain or swelling
  • high temperature
  • dark or smelly vaginal discharge

What are the risks?

Vaginal repair is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic.

You will have some pain and discomfort in your abdomen. You will also have some vaginal bleeding, similar in amount to a normal period. This may last for up to a month.

Complications

This is when problems occur during or after the operation. Most women are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications specific to vaginal repair are uncommon but can include:

  • infection - antibiotics can help treat infection
  • damage to the womb, vagina or cervix, and/or part of the bladder or bowel - this may require further surgery to repair the damage
  • pain on passing urine - this usually improves without further treatment

It's possible that the vagina may lose its support again and require further treatment. Your surgeon may recommend a hysterectomy at the same time as a vaginal repair to reduce the risk of this happening.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Further information

Related topics

Sources

  • Surgical repair of vaginal wall prolapse using mesh. National Institute for Health and Clinical Excellence (NICE), 2008. www.nice.org.uk
  • Pelvic floor repair and vaginal hysterectomy for prolapse. Royal College of Obstetricians and Gynaecologists, 2004. www.rcog.org.uk

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Mr Naim Boutros, MBchB, LRCP, MRCS, MRCOG, Dip Ultrasound, Consultant Obstetrician and Gynaecologist, Medway Maritime Hospital NHS Trust, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2008.

 

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