It is performed to repair the vaginal walls (front and / or back walls). It generally involves making a cut along the vaginal walls, allowing access to the prolapsing structures, either the bowel or bladder or both. The prolapsing structures are pushed back, and the surrounding tissues are reinforced and strengthened. Depending on the site of the prolapse, some of the muscles around the back wall of the vagina may also be tightened (a perineorraphy). The vagina is then closed with dissolvable stitches.
The operation may be combined with either a laparoscopic or vaginal hysterectomy (removal of the womb and cervix – see separate sheet). Occasionally the vaginal repair is also performed laparoscopically, most often if you are already having a laparoscopic operation. If you are suffering with urinary stress incontinence, the doctor may also perform additional surgery (see separate sheet)
What happens after the operation?
After the operation, you may experience nausea and wound pain. Medication will be given to relieve these symptoms. You will normally be allowed to drink and eat on the same day of operation. The urinary catheter will normally be removed later on the following day. The nurse looking after you will make sure you are passing water without a problem and check there is not a large volume of urine left in the bladder after you have finished urinating. A small number of women will not adequately empty their bladders. They may have to go home with a catheter in and come back a week later for removal of the catheter. If a vaginal pack / bandage is used at the time of surgery, it is removed the following day.
There is likely to be some vaginal bleeding after surgery, and this may take a few days to settle down. You are likely to experience pain in the abdomen / pelvis that will require regular painkillers for up to a couple of weeks following surgery. Providing there are no problems you will be allowed home one-four days after surgery.
Are there any risks?
Vaginal repair is a safe and effective operation, but as with any surgical procedure there are risks. The risks common to all operations include anaesthetic risks, infection, bleeding, recurrence of symptoms, and formation of a blood clot in the legs/lungs. The main risks specific to a vaginal repair are:
- This includes bowel, bladder or ureters (pipes leading from the kidneys to the bladder). The risk of this is small although is increased the more abdominal / pelvic operations you have had. In general, if such a complication were to occur, we would repair the damage that had been caused. This may mean repairing the bladder, and may mean that the catheter (plastic tube to drain the bladder) has to be kept for a couple of weeks after surgery. It may mean repairing the bowel (and perhaps requiring a larger cut or “laparotomy”) and this may mean that parts of the bowel need to be temporarily rested and a special bag (“colostomy”) used for a few weeks following surgery. A laparoscopy (inserting a fine camera into the abdomen) may be required if there are problems encountered during surgery that require immediate investigation or treatment. These risks are uncommon, but every woman is warned about them.
- Many women complain of these symptoms prior to surgery, and may be improved by surgery. Some women notice a worsening or urinary leakage after prolapse surgery. This occurs not because the surgery has caused the problem, but that it reveals a pre-existing problem with the bladder. The prolapse had previously been masking the bladder incontinence problem, and now that the prolapse is corrected, the baldder problem becomes apparent. This affects a small number of women, may be predictable before the operation depending on your symptoms, examination findings and tests, and is often relatively easily treated following surgery. Some women may require a subsequent small surgical procedure to correct this problem.
- Scarring and problems with sexual intercourse. Any operation carries the risk of scar tissue forming. This scar tissue is most apparent a few weeks after surgery, and generally resolves over a period of a couple of months. It is not noticed by most women. In a small minority of women, the scar tissue may be uncomfortable whilst making love. Again, for most women this resolves with time, although some women may need to have further medical or surgical treatment to remove the scarring.
- Recurrence of prolapse symptoms. As prolapse is a problem that involves weak muscles / tissue, although a surgical repair has been performed, prolapse may recur at the same site or in a different part of the vagina that has not been apparent or planned to be repaired at the initial operation.
- Urinary Retention: (Difficulty or failure to pass urine) This is quite common as a temporary problem and means that your catheter may need to stay in place for a couple of weeks. In a very small number of women, (1-2%), the bladder continues to not empty adequately, and women may need to learn to self-catheterise. This latter process involves passing a very fine straw size catheter into the bladder on a daily basis. This outcome is uncommon, unless you have a problem prior to surgery, but every woman needs to be aware of this.
- Urgency: Some women have an element of urgency (needing to rush to the toilet) prior to the operation. For them, this symptom may get marginally better or worse. Occasionally for other women, there may be new symptoms of urgency. This generally only lasts a few months and can be treated with tablets.
What should I do after the operation?
You should be back on your feet quite quickly, but you avoid heavy lifting for 6 weeks. There may be some bleeding / brown vaginal discharge as the wounds in the vagina heal which is completely normal.
Sexual intercourse may be resumed after 6 weeks if you are feeling comfortable and the discharge has stopped. We generally suggest at least 4 weeks off work.