Colpocleisis

Overview

Colpocleisis is a surgical solution for Pelvic Organ Prolapse (POP), a condition where pelvic organs, such as the vagina, uterus, urethra, bladder, and rectum, may descend due to weakened muscles and connective tissues in the pelvic floor. This descent can result in the protrusion of one or more organs through the vaginal opening.

The two main types of surgery for treating POP are reconstructive procedures and obliterative procedures. Colpocleisis is an obliterative procedure that does not require abdominal incisions. During the surgery, the surgeon repositions the pelvic organs into the pelvic cavity and uses dissolvable sutures to close the vaginal walls. This closure prevents the recurrence of POP by providing structural support to the weakened pelvic floor muscles and tissues.

Reasons for undergoing the procedure

If you require surgery to address Pelvic Organ Prolapse (POP) but are not considered an ideal candidate for reconstructive procedures, colpocleisis may be recommended. This option might be suitable if:

• You intend to stop engaging in vaginal sex. After colpocleisis, your vaginal canal will be too short for sexual activity.
• Reconstructive surgery is not tolerated by your body. If your medical issues prevent you from undergoing reconstructive surgery, colonoplevis is a good option.
• Conservative therapy are not appropriate for your severe POP. Exercises that strengthen the pelvic floor, such as Kegel exercises, can assist in realigning your organs when POP is mild. Medical devices, like a vaginal pessary, can also aid in managing POP. Surgery is necessary if your pelvic organs protrude outside of your vagina.

Risks

Complications from colpocleisis are rare. Age is not a risk factor for problems; nonetheless, the majority of patients are in their 80s or 90s after undergoing this treatment. Rather, risk is determined by your general health status.

Colpocleisis carries risks that are comparable to those of ordinary surgery:

• Infection
• Blood clots
• Injury or bleeding to a nerve or muscle during surgery.

After undergoing surgery to treat POP, between 13% and 65% of patients experience Stress Urinary Incontinence (SUI). Discuss your chance of having SUI following surgery with your doctor. You can get advice from your doctor about whether surgery is necessary to avoid this condition.

Before the procedure

Before proceeding with surgery, your doctor will evaluate your overall health to determine if you are a suitable candidate. Additionally, they will engage in discussions with you regarding potential impacts on your sexual activity and options for diagnostic screenings.

Following colpocleisis, intercourse may be affected as the vaginal canal becomes shortened. Furthermore, several diagnostic procedures aimed at detecting diseases affecting the reproductive organs may no longer be feasible, as many of these rely on access to the vagina and cervix. Understanding these changes and consenting to them is crucial before undergoing surgery.

Health examination

During the evaluation of your health, your doctor might:

• Examine your medical history, taking into account any current prescriptions.
• Get a history of your pelvic floor; if you have problems passing stool or urine, inquire about incontinence.
• Evaluate the symptoms of your POP (ask if you have any skin irritation or bleeding, if your vagina feels like it’s expanding, and if you feel pressure in your pelvis).
• Order some blood tests.
• Get an electrocardiogram (EKG) to look for indications of cardiac problems.

To help you get ready for surgery, your doctor might give you advice on nutrition and exercise. One of these suggestions might be to give up smoking four to six weeks before to your surgery. Smoking can make recovery more difficult and raise the possibility of problems.

Diagnostic tests
Following a colpocleisis, diagnostic procedures requiring access to the vaginal canal become inaccessible. Depending on your post-surgery risk factors for conditions such as Stress Urinary Incontinence (SUI), cervical cancer, or uterine cancer, your doctor may suggest preventive surgeries. For instance, if you have a high risk of uterine cancer, your doctor may recommend a hysterectomy to remove your uterus.

Before undergoing colpocleisis, your doctor may perform tests or procedures that necessitate access to the vaginal canal to assess your health. These procedures may encompass:

• Transvaginal ultrasound
• Pap smear
• Cervical cytology
• Endometrial biopsy

See your doctor about the connection between your disease risk and having a colpocleisis. Occasionally, you can require preventive surgery. In other cases, there may be needless risk associated with prophylactic surgery.

During the procedure

During a colpocleisis procedure, which typically takes about an hour, your doctor will:

• Administer either regional anesthesia (if you are awake) or general anesthetic (if you are asleep) to ensure you are pain-free.
• Place a catheter within your bladder to assist with urination during the procedure.
• Have you wear compression stockings on your lower limbs to prevent blood clots.
• Cut the thin lining of the vagina from the vaginal muscle. The amount of skin removed depends on whether you are having a complete or a Le Fort colpocleisis.
• Use dissolvable sutures to join the vaginal walls together.

After the procedure

Following surgery, you should expect a significant reduction in the length of your vaginal canal (from around 4 inches to 1 inch) and a smaller vaginal opening. Your external genitalia (vulva) and the exterior of your vagina will have the same appearance.

On the day of your procedure, you have the option of leaving the hospital or remaining overnight. Your doctor will decide before you leave whether to have your catheter taken out or left in place for a few days while you heal. If necessary, your doctor can instruct you on how to use a catheter. Make arrangements for a ride home from the hospital.

Within two to four weeks of your operation, schedule a follow-up appointment with your doctor. Over a period of days, weeks, or months, you can experience certain uncomfortable sensations; they are all a normal part of the healing process.

• Problems emptying your bladder (urinary retention): Following surgery, you might find it difficult to urinate without a catheter, but things should get better eventually.
• Constipation. After your surgery, you might need to take laxatives or stool softeners for a period.
• Vaginal bleeding and pain in the area between your anus and vagina (perineum): these symptoms normally go away after a week. You can reduce your pain by taking over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen or aspirin.
• Yellowish vaginal discharge: This is simply the dissolution of your stitches. The time it takes for your stitches to fully heal is anything from six to eight weeks.

Outcome

In the initial two weeks post-surgery, you can expect to feel fatigued and experience discomfort. Within a few days to a few weeks, you may start feeling well enough to engage in daily activities such as driving and walking. However, it might take up to six weeks for you to fully recover and return to work.

During your recovery period, it’s important to avoid strenuous exercise and heavy lifting. Prior to your surgery, it’s advisable to complete any necessary errands and stock up on groceries to ensure a smooth and uninterrupted healing process.