Colporrhaphy

Overview

Colporrhaphy is a surgical procedure designed to repair weaknesses in the vaginal walls, commonly used to treat pelvic organ prolapse (POP). POP occurs when the organs within the pelvis descend because the muscles and tissues supporting the vaginal wall become too weak to maintain their position. Colporrhaphy strengthens these muscles and tissues, enabling them to support pelvic organs such as the bladder and rectum effectively.

Types of colporrhaphy

There are two types of colporrhaphy, which may be performed individually or together, sometimes in combination with other procedures to address vaginal wall defects:

Anterior colporrhaphy (cystocele repair)

• Problem: Weakened muscles between the bladder and vagina can cause the bladder to droop onto the front wall of the vagina, a condition known as anterior wall prolapse.
• Solution: Anterior colporrhaphy tightens the muscles in the front wall of the vagina to hold the bladder in place.

Posterior colporrhaphy (rectocele repair)

• Problem: Weakened muscles between the rectum and vagina can cause the rectum to droop onto the back wall of the vagina, a condition known as posterior wall prolapse.
• Solution: Posterior colporrhaphy tightens the muscles in the back wall of the vagina to hold the rectum in place.

These procedures are crucial in restoring the proper function and support of the pelvic organs, improving the patient’s quality of life.

Reasons for undergoing the procedure

Colporrhaphy provides relief from the symptoms of POP, which can greatly affect your quality of life. Issues like urinary or fecal incontinence and painful intercourse can be distressing, but colporrhaphy targets the structural concerns in the pelvis, easing these symptoms and restoring comfort and function.

You may be considered a candidate for colporrhaphy if:

• Your POP symptoms have not improved with conservative therapies. The first line of treatment for POP is non-invasive procedures to support your organs or strengthen your pelvic floor muscles. These therapies include hormone therapy, pessary devices, and pelvic floor exercises (Kegels).
• You’re having uncomfortable symptoms. Many POP patients don’t have symptoms that significantly interfere with their daily life. If POP isn’t bothering you, you might not want to chance the dangers that come with any surgery, including colporrhaphy.
• You don’t intend to start a family. Having a kid after a colonoscopy may make structural problems and symptoms more likely to recur. It could be wisest to put off surgery until after you’ve had all of your kids.

Risks

Common side effects are possible to encounter:

• Urinary retention, or difficulty emptying your bladder entirely, may occur a few days after surgery.
• After surgery, you can experience vaginal bleeding for a few days.
• After surgery, you can experience a creamy vaginal discharge for a few weeks. The discharge indicates that the sutures are being absorbed by your body.
• You might feel soreness in your vagina. In four to six weeks, it ought to disappear.

After surgery, your doctor might advise a follow-up examination four to six weeks later. If your doctor gives you guidance on when to make follow-up appointments, heed their advice.

Discuss factors prior to surgery, such as your overall health and any underlying medical concerns.

Among the complications are:

• Constipation.
• Severe bleeding.
• Painful sexual relations.
• Response to the sedative.
• Infection at the site of the wound.
• Damage to the organs in your pelvis.
• Urinary tract infection.
• Incontinence of the bowels and/or urine.

In order to strengthen your repair, your surgeon might advise mesh. These procedures carry a slight risk of mesh exposure. A particular kind of mesh was outlawed by the FDA in 2019 and is no longer in use. Further research has demonstrated that the mesh that is currently on the market is safe for POP repairs.
If you have had a mesh colonoscopy in the past, discuss any possible risks with your doctor.

Before the procedure

To ensure you have all the information you need to determine whether this surgery is best for you, your doctor will go over the advantages and disadvantages of colporrhaphy with you.

Prior to the operation, your doctor will:

• Examine your medical history and symptoms. Your symptoms may offer hints that enable your healthcare expert to determine precisely where your muscles require reinforcement. This information enables your surgeon to use certain surgical procedures throughout your procedure that target different parts of your vaginal wall.
• Conduct a bimanual pelvic exam. Your doctor will press onto your abdomen and place two fingers inside your vagina. Using this method, they can detect weak places in your vaginal wall and feel for drooping pelvic organs.
• Order imaging or lab work, as needed. Frequently, more imaging is not required. However, in order to investigate more closely for pelvic floor muscle abnormalities, your doctor might prescribe an MRI.
• Give antibiotic prescriptions to lower the possibility of infection during surgery. On the day of your procedure, you can frequently take an antibiotic as a single dose.
• Before surgery, your doctor can recommend topical or vaginal estrogen if you’ve experienced menopause. According to available data, estrogen may thicken your vaginal tissue, making it easier to work with after surgery.

During the procedure

To keep you comfortable, your doctor will first administer anesthesia. You will then be seated on a table with padded footrests to support your lower limbs. With your legs raised and your knees bent to a 90-degree angle, you will lie on your back with your calves supported by the footrests. Your doctor can more easily access your vagina and the tissue between it and your anus (perineum) in this position, known as the dorsal lithotomy position.

As soon as you’re positioned comfortably, your doctor will:

• Insert a bladder catheter to catch pee during the procedure and either general anesthesia (you are sleeping) or regional anesthesia (you are numb but aware).
• To make it simpler to examine your vaginal walls, widen your vagina with a speculum.
• Create a vertical incision (cut) to reveal your vaginal wall’s muscles and tissues.
• To access the weaker areas of your vaginal wall, make tiny, accurate incisions along the top wall (for anterior colporrhaphy) or the back wall (posterior colporrhaphy).
• Stitch your vaginal wall’s sturdy sections together.
• Use absorbable stitches to seal the incision.

If the weakening of the muscles is limited to a small area, surgery could be completed in as little as 30 minutes. If more extensive repairs are required for your vaginal wall, colporrhaphy can take longer.

After the procedure

The amount of your vaginal wall repairs will determine whether you may go home the same day of the procedure or if you have to spend the night in the hospital.
After surgery:

• To stop the bleeding, your doctor could put a pack in your vagina. Usually, it can be taken off after a day.
• Your doctor will determine whether you require a catheter or if you can urinate on your own. After a colonoscopy, most catheters can be removed in 48 hours.
• You might be prescribed a stool softener or mild laxative to help you go to the bathroom without straining your mending muscles and tissues.
• If you have experienced menopause, you might be prescribed vaginal estrogen. Research indicates that following surgery, estrogen may hasten recovery and lower your risk of Urinary Tract Infection (UTI).

Outcome

Depending on the extent of your colporrhaphy, complete recovery typically takes around three months. During this period, your doctor may advise you to:

• Use stool softening agents for a maximum of three months.
• Avoid straining during bowel movements for at least six weeks post-surgery.
• Refrain from lifting anything heavier than five pounds and engaging in strenuous activities like jogging or weightlifting for at least six weeks post-surgery.
• Opt for showering instead of bathing for a minimum of six weeks post-surgery.
• Avoid douching, sexual intercourse, or using tampons in your vagina for six to eight weeks post-surgery.

You may be able to resume driving and going for walks in three to four weeks, and possibly even return to work. However, the duration of your surgery and the physical demands of your job will influence when you can fully resume regular activities. Inform your doctor about the physical requirements of your job when discussing your rehabilitation plan.