Colporrhaphy

 

If you require the services of an interpreter, contact us on 020 3447 4735. We will do our best to meet your needs.

Contents

1. Introduction 3
2. What does colporrhaphy mean? 3
3. How can a colporrhaphy help? 4
4. What are the risks of colporrhaphy? 5
5. What will happen if I choose not to have a
colporrhaphy? 13
6. What alternatives are available? 14
7. How should I prepare for a colporrhaphy? 15
8. Asking for consent 18
9. What happens during a colporrhaphy? 19
10. What should I expect after colporrhaphy? 19
11. Where can I get more information? 23
12. References 23
13. Contact details 26
14. How to find us 27
15. Space for notes and questions 28

 

1 Introduction

Vaginal prolapse is a condition where the vaginal walls become weakened and bulge downwards. You may feel that ‘something is coming down’ in the pelvis or have symptoms of a lump or bulge in the vagina. Prolapse can sometimes affect how your bladder or bowels work.

This leaflet provides information about an operation called colporrhaphy. We offer this procedure to treat prolapse of the vaginal walls. This leaflet has been made to help you understand why this operation has been recommended and what surgery might involve.

This leaflet contains information from medical research studies and guidance from independent organisations that specialise in this type of surgery. We have tried to simplify this information
and make it easy to understand for patients. We hope that this leaflet will help you decide if you want to go ahead with surgery. 

We will review this information every two years. This is to make sure that any information from new research studies is included. We may do this sooner if we think important new information
becomes available that you need to be aware of.

2 What does colporrhaphy mean?

Colporrhaphy is an operation used to repair prolapse of the vaginal walls. A cut is made in the skin of the vagina and internal stitches are placed to strengthen the area. This stops the area bulging down and should make you feel better. 

It is helpful to think of the vagina as having a ‘front’ wall and a ‘back’ wall. Both of these areas can be affected by prolapse.

  • The front wall of the vagina can be felt if a finger is placed in the vagina and pointed towards the head. The bladder is directly above the front wall of the vagina.
  • The back wall of the vagina can be felt if a finger is placed in the vagina and pointed towards the feet. The lower bowel is directly below the back wall of the vagina.


You may need a colporrhaphy operation on the front or back wall of the vagina. This depends on which part of the vaginal wall is affected by prolapse. Sometimes the front and back walls may need surgery at the same time.

You may have heard prolapse of the ‘front’ and ‘back’ walls of the vagina described as a ‘cystocele’ and ‘rectocele’. These are medical terms. To avoid confusion, we will talk about prolapse
of the ‘front’ and ‘back’ walls of the vagina in this leaflet.

3 How can a colporrhaphy help?

If you have symptoms of vaginal wall prolapse, colporrhaphy is likely to help you. Unfortunately, no operation will work for everybody and sometimes the surgery will not successful. For some women, surgery works well initially but the problem comes back again later.

How well the operation works depends on whether the prolapse affects the front or back wall of the vagina. The most reliable medical research studies (called randomised trials) have shown
that two years after surgery, most women are satisfied:

  • Around 90 out of 100 women who have a colporrhaphy for prolapse of the back wall of the vagina will have no symptoms of prolapse.
  • Around 70 out of 100 women who have a colporrhaphy for prolapse of the front wall of the vagina will have no symptoms of prolapse.


Other types of research have continued to monitor patients for up to five years after surgery. Unfortunately, the results of these studies are not reliable enough to help us decide how well colporrhaphy works long term.

Because the bowel and bladder are so close to the vagina, vaginal surgery can affect how the bowel and bladder work. 

This means that bladder and bowel problems may get better after colporrhaphy.

Some women experience ‘stress urinary incontinence’. This means urine leakage on coughing, sneezing, or physical activity. ‘Urinary urgency’ describes having to suddenly rush to the toilet to pass urine. Sometimes urine leaks out on the way to the toilet.

If you have a colporrhaphy for prolapse of the front wall of the vagina, your urinary symptoms may improve:

  • Around 50 out of 100 women will report improvements in stress urinary incontinence.
  • Around 70 out of 100 women will report improvements in urinary urgency.

In addition, around 80 out of 100 women with problems passing urine before surgery may see improvements after surgery.

If you have bowel symptoms, they might improve if you have a colporrhaphy for prolapse of the back wall of the vagina. You might have better control over your bowels, less trouble emptying the bowels, or even less leakage:

  • Around 70 out of 100 women will report improvements in bowel symptoms.


4 What are the risks of colporrhaphy?

All treatments and procedures have risks and we will talk to you about the risks of colporrhaphy. Problems that occur during or after surgery are called complications. These are undesirable or
unwanted effects that happen as a result of surgery. If a complication affects you, it does not mean that something must have gone wrong during the surgery.

If you have a complication, you can expect us to explain what has happened, and whether any further treatment is required. We always provide additional care and support for patients who
experience problems after an operation.

We will use numbers to explain how often we might expect problems to happen after colporrhaphy. For example, a ‘10 in 100’ chance of a problem means that if we performed 100 operations, the problem would happen 10 times. This is the same as a 10 per cent chance.

Problems that may happen straight away

Bleeding during surgery

  • Bleeding that might need a blood transfusion: 1 in 100.

Infections after surgery

  • Urine infection immediately after surgery: 10 in 100.
  • An infection of the vaginal wounds: 1-5 in 100.

 

Damage to other organs during surgery
If you are having a colporrhaphy of the front vaginal wall, the bladder, urethra, and ureters can be damaged. The urethra is the tube that you pass urine from. The ureters are the tiny tubes inside your body that carry urine from the kidneys to the bladder.

  • Damage to bladder, urethra or ureters: 1-2 in 100.

    If you are having a colporrhaphy of the back vaginal wall, the
    lower bowel can be damaged.
  • Damage to bowel: 1-2 in 100.

If you are affected, the damaged organs will be repaired during the operation. Sometimes a cut on your abdomen called a laparotomy is needed in order to fix things. If you have had previous abdominal or pelvic surgery the risk of damage may be higher.

Rarely, damage might occur that is not recognised during the operation. If this happened, you might experience no symptoms, or you could become ill after your surgery. You would need to extra tests to find out if this was the case. You might need another operation to repair the damage. 

 

Bladder and bowel symptoms after surgery

Some women have bladder and bowel symptoms as well as prolapse. Although these symptoms often improve after colporrhaphy, sometimes they can get worse. In addition, there is a small risk that you could be troubled by new symptoms after surgery that were not there before.

The bladder is directly above the front wall of the vagina.
Because of this, a colporrhaphy of the front vaginal wall may affect how your bladder works:

  • New or worsening stress urinary incontinence: 10-15 in 100.
  • New or worsening urinary urgency: 5 in 100.
  • New or worsening problems with bladder emptying: 5 in 100

 

The bowel is directly below the back vaginal wall. For this  reason, a colporrhaphy of the back vaginal wall might change how the bowel works. If you already have bowel symptoms, the risk of hem worsening is small. It is difficult to be sure exactly how often this happens. The available research suggests that bowel symptoms worsen after surgery in 5-10 in 100 women.

Some women develop new bowel symptoms after colporrhaphy for prolapse of the back vaginal wall. The available research suggests that new symptoms are uncommon:

  • Difficulty emptying the bowels: 5 in 100.
  • Having to rush to the toilet without warning: 5 in 100.
  • Leakage of gas: 10 in 100
  • Leakage of faeces: 1-2 in 100.


Although a colporrhaphy of the back vaginal wall might affect how the bowel works, it can sometimes affect the bladder. This might seem confusing, as the bladder is above the front vaginal
wall, not the back wall.

Painful  sexual  intercourse and  vaginal  pain

If you do not have problems with painful sexual intercourse before surgery, it is unlikely that you will have problems afterwards. The risk of developing problems seems to depend on which part of the vagina is being operated on:

  • If you have a colporrhaphy of the front wall of the vagina, the risk of painful sexual intercourse is 5-10 in 100.
  • If you have a colporrhaphy of the back wall of the vagina, the risk of painful sexual intercourse is 10-15 in 100.


It is possible that you could develop pain in the vagina after surgery that is there all the time. We do not know how often this happens but it is likely to be rare.
If you already experience chronic pain in other areas of the body, the risk of pain symptoms after surgery is higher.

Problems that may happen later

Your prolapse could continue to be a problem

Some women find that their prolapse comes back soon after surgery. This could be a problem just a few weeks after your operation. In others, things are better at first, but the prolapse comes back later. The risk of the prolapse coming back depends on which part of the vagina is operated on. Two years after surgery, research studies have found that:

  • If you have a colporrhaphy of the front wall of the vagina, the risk of vaginal prolapse coming back is 30 in 100.
  • If you have a colporrhaphy of the back wall of the vagina, the risk of vaginal prolapse coming back is 10 in 100.

It is worth remembering that even if your colporrhaphy surgery works, you could have problems in the future. This is because you might develop a prolapse in another part of the vagina, or prolapse of the womb. These problems might need further treatment.

Problems that are rare, but serious

  • Blood clots in the legs that can travel to the lungs: 5 in 1000.

Problems with the anaesthetic

You will be given a general anaesthetic for your operation. This means that you will be unconscious and will not feel anything during your surgery. Anaesthetists are doctors who specialise in
anaesthetics. Your anaesthetist will give you your anaesthetic medication and gently place a tube through your mouth into your throat. This is to keep your windpipe open so oxygen can get to your lungs.

Some problems are very common after an anaesthetic. They normally settle down very quickly after surgery or are easy to treat. Sore throat or throat pain, feeling sick and vomiting, or shivering after surgery, can affect up to half of patients. Some problems are more likely to affect certain groups of patients.

If you are older, overweight, a smoker, or have other medical problems, you are more likely to be affected:

  • Chest infection after surgery: 1-10 in 100.
  • Permanent nerve damage: 1 in 1000.
  • Permanent loss of sight: 1 in 100,000.
  • Death as a result of anaesthesia: 1 in 100,000.

Older patients, especially those with dementia, poor eyesight or  hearing, can become confused after an operation. It is not known how often this happens.

Damage to the lips and tongue may occur but this is usually minor. Tooth damage is more likely to happen if you have diseased teeth and gums, or have had extensive dental work:

  • Damage to the lips and tongue: 5 in 100.
  • Damage to teeth: 5 in 10,000.

Some problems can happen to anyone as a result of an anaesthetic:

  • The eyeball getting grazed or damaged: 4 in 10,000.
  • Being aware of what is happening during surgery despite the anaesthetic: 5 in 100,000.
  • Life-threatening allergic reaction: 1 in 10,000.


5 What will happen if I choose not to have colporrhaphy?

If you decide not to have this operation you could simply carry on as you are. You will continue to have symptoms of prolapse. Whilst these symptoms can be distressing, you are unlikely to come to any harm.

6 What alternatives are available?

After reading this leaflet, you may decide that you want to look at other options. We provide a separate leaflet on the available treatments for prolapse and we should have given you this to read. Please ask for this leaflet if you do not already have it.

The alternatives to colporrhaphy are:

  • Pelvic floor physiotherapy.
  • A vaginal pessary.

Sometimes your doctor may suggest that one treatment might be better than another in your particular case. They will obviously provide you with the reasons why this is so

7 How should I prepare for Colporrhaphy?

The Preoperative Assessment Clinic (PAC)

Before your operation, you will be seen in the PAC to make  sure that you are fit for your surgery. Specialist nurses and anaesthetists run the clinic. This normally happens a few weeks before your operation.

When you come to your appointment, you should bring the following:

  • A list of your medical conditions and previous operations.
  • A list of your current medications and allergies.


Sometimes, certain types of medication need to be stopped before your operation. The team in PAC will tell you if any of your medication needs to be stopped and which ones you should take on the day of your operation.
Please do not stop any medication before your operation unless you are asked to do so. Stopping important medication before your surgery may mean that your operation is cancelled or you come to harm.

The day of your surgery

On the day of surgery, you will come to the Surgical Reception on the First Floor of University College Hospital at 07:00 in the morning. You will receive a letter confirming these details. Your operating surgeons will see you for final checks. Please note that your operating surgeon may not be the same specialist as you saw in clinic. The nurses will then prepare you for your surgery. You may be given an enema to clear out the lower bowel if you are having a colporrhaphy of the back wall of the vagina.

On the day of surgery, you should follow the instructions given to you at the PAC appointment about the following:

  • Which medications to take on the morning of surgery.
  • When to stop eating and drinking before your surgery.

If you are confused about any of the instructions, you must contact them before your surgery. Their details are at the end of this leaflet.

  • Bring your regular medications along with you.
  • Pack a bag with clothes and toiletries for your stay.
  • Bring the copy of your consent form that we gave you.

Please be aware that your surgeons will be operating through the day until 19:00. They are often unable to leave the operating theatre between patients. For this reason, they see all patients in the morning, even if surgery is planned for later in the day.

If your surgery is in the afternoon, you may be allowed to drink some water. You might also be able to leave the Surgical Reception for a little while until you are due for surgery. Please do not drink, or leave the Surgical Reception, until instructed to do so. Drinking at the wrong time may mean that your operation is cancelled.

There is a very small chance that your surgery may be cancelled on the day you come in to hospital. This might happen because the hospital is full and there is no bed for you. This is uncommon but obviously very distressing if it occurs.

Whilst beds often become available as the day passes, this is not always the case. If it looks like your surgery will have to be cancelled, we will let you know as early as we can. We will then work with our management team to rearrange your surgery as soon as possible. 

Making plans for after your surgery

Please make plans well in advance:

  • You will be in hospital for one or two nights. Up to two people can visit you in hospital between 09:00 and 20:00 every day.
  • Please ensure that your travel plans are flexible. Remember that your stay might also be extended on medical grounds.
  • You will need an escort to help you get home and you will not be able to use public transport to get home alone.
  • You will need six weeks off work. If you have a very strenuous job you may need slightly longer to recover.
  • You should avoid carrying anything heavier than 5kg during this time.
  • You will need friends and family to help with groceries and household chores, particularly in the first week or two.

Unfortunately, we will be unable to extend your hospital stay if  you have not made transport arrangements. If you already use hospital transport because of a medical illness, we will be able to help arrange this. Unfortunately, hospital transport is not available for other patients.


8 Asking for your consent

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. Staff will explain all the risks, benefits and alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please ask to speak with a senior member of staff again. Our contact details are at the end of this leaflet.

9 What happens during a colporrhaphy?

  • The operation takes around one and a half hours. A cut is made in the vaginal skin over the prolapse. This will be on the front or back vaginal wall, depending on the location of your prolapse.
  • If you are having surgery on the back wall of the vagina, the cut might extend on to the perineum. This is the skin between the vagina and the anus.
  • The prolapse is then repaired using strong internal stitches.
  • The cut in the vaginal skin is then closed up using stitches.
  • We might insert a ‘vaginal pack’ at the end of your surgery.
  • This is a rolled up bandage placed inside the vagina to help stop any minor bleeding. The pack is usually removed within 24 hours.
  • You will have a drip in your hand and a catheter tube in the bladder. These will normally be removed within 24 hours.

All of the stitches used will dissolve and do not need to be removed. The internal stitches might take a few months to dissolve. The stitches in the vaginal skin usually dissolve in a few weeks.

10 What should I expect after colporrhaphy?

The first two weeks after surgery

  • You will need to rest and take regular painkillers.
  • You should take regular medicine, known as a laxative, to keep your bowels opening every day.
  • You will spend much of your time at home but you may take short walks. You should avoid anything strenuous and lifting anything heavier than 5kg.
  • You can expect some vaginal bleeding and discharge.
  • You will wear a sanitary pad and change it regularly.
  • You can shower as often as you like. You can gently wash around the vaginal opening in the shower. You can direct the shower spray around the vaginal entrance to clear away any discharge or blood. You can use soap or shower gel on the outside of the vagina but not on the inside.
  • If you do take a bath, do so in shallow water for a maximum of ten minutes.
  • In the first two weeks, we think it is a good idea to gently wash around the vagina twice a day. This is in addition to your daily shower or bath.
  • You will receive a telephone clinic appointment through the post. This is normally scheduled for two to three weeks after surgery. The urogynaecology nurses will call you by phone on this day to check on your progress.

We will give you a two-week supply of painkillers, laxative medication, and any other drugs you will need at home. If you need further supplies after you have gone home, you will need to contact your GP.

Weeks two to six after surgery

  • You will be able to reduce your regular painkillers, start taking them only if needed, and eventually stop using them.
  • You will continue to use your laxatives to keep your bowels opening daily. If you can do this by eating plenty of fruit and fibre, and drinking enough water, you can stop the laxatives.
  • You can increase your activity, go out for longer walks, and visit friends and family, provided you take things easy.
  • You will continue to avoid lifting anything heavier than 5kg.
  • You can start driving again but you should inform your insurance company that you have had surgery. They must be happy for you to drive again. You should only start driving again if you feel safe to do so. You must be able to perform an emergency stop if needed.
  • Your vaginal bleeding and discharge will eventually stop.
  • If you have a period, please use pads rather than tampons.

Six weeks onwards

  • You can get back into your normal routine and return to work. If you have a strenuous job, you may need slightly longer to recover. Please let us know if this is the case.
  • If you exercised regularly before your surgery, please discuss this with us before you go home. We might suggest some changes to your usual exercise programme.
  • You can start having sexual intercourse.
  • We will send you a clinic appointment through the post for three months after your surgery. At the appointment, we will ask you how things are and examine you. This is to make sure
    that the operation has worked and that you do not have any problems.

11 Where can I get more information?

The British Society of Urogynaecology
Website: www.bsug.org.uk/patient-information.php
Email: bsug@rcog.org.uk
Telephone: 020 7772 6211
Fax: 020 7772 6410

The National Institute for Health and Care Excellence
Website: www.nice.org.uk/guidance/ipg282/informationforpublic
Email: nice@nice.org.uk
Telephone: 030 0323 0140
Fax: 030 0323 0748

The International Urogynecological Association
Website:
http://www.iuga.org/general/custom.asp?page=patientinfo
Email at: www.iuga.org/general/?type=CONTACT
UCLH cannot accept responsibility for information provided by
other organisations.

12 References

Aarts, J. W., T. E. Nieboer, N. Johnson, E. Tavender, R. Garry,
B. W. Mol and K. B. Kluivers (2015). “Surgical approach to
hysterectomy for benign gynaecological disease.” Cochrane
Database Syst Rev(8): CD003677.

Abdel-Fattah, M., A. Familusi, S. Fielding, J. Ford and S.
Bhattacharya (2011). “Primary and repeat surgical treatment for
female pelvic organ prolapse and incontinence in parous
women in the UK: a register linkage study.” BMJ Open 1(2):
e000206.


Abramov, Y., S. Gandhi, R. P. Goldberg, S. M. Botros, C. Kwon
and P. K. Sand (2005). “Site-specific rectocele repair compared
with standard posterior colporrhaphy.” Obstet Gynecol 105(2):
314-318.

Ayabaca, S. M., A. P. Zbar and M. Pescatori (2002). “Anal
continence after rectocele repair.” Dis Colon Rectum 45(1): 63-
69.

Brummer, T. H., A. M. Heikkinen, J. Jalkanen, J. Fraser, J.
Makinen, E. Tomas, T. Seppala, J. Sjoberg and P. Harkki
(2013). “Antibiotic prophylaxis for hysterectomy, a prospective
cohort study: cefuroxime, metronidazole, or both?” BJOG
120(10): 1269-1276.

Desciak, M. C. and D. E. Martin (2011). “Perioperative
pulmonary embolism: diagnosis and anesthetic management.” J
Clin Anesth 23(2): 153-165.

Digesu, G. A., S. Salvatore, C. Chaliha, S. Athanasiou, R.
Milani and V. Khullar (2007). “Do overactive bladder symptoms
improve after repair of anterior vaginal wall prolapse?” Int
Urogynecol J Pelvic Floor Dysfunct 18(12): 1439-1443.

Feldner, P. C., Jr., R. A. Castro, L. A. Cipolotti, C. A. Delroy, M.
G. Sartori and M. J. Girao (2010). “Anterior vaginal wall
prolapse: a randomized controlled trial of SIS graft versus
traditional colporrhaphy.” Int Urogynecol J 21(9): 1057-1063.

Forsgren, C., J. Zetterstrom, A. Lopez, J. Nordenstam, B.
Anzen and D. Altman (2007). “Effects of hysterectomy on bowel
function: a three-year, prospective cohort study.” Dis Colon
Rectum 50(8): 1139-1145.

Gustilo-Ashby, A. M., M. F. Paraiso, J. E. Jelovsek, M. D.
Walters and M. D. Barber (2007). “Bowel symptoms 1 year after
surgery for prolapse: further analysis of a randomized trial of
rectocele repair.” Am J Obstet Gynecol 197(1): 76 e71-75.


Hokenstad, E. D., E. B. Habermann, A. E. Glasgow and J. A.
Occhino (2016). “Risk of venous thromboembolism in patients
undergoing surgery for pelvic organ prolapse.” Int Urogynecol J.

Humalajarvi, N., P. Aukee, M. V. Kairaluoma, B. StachLempinen, H. Sintonen, A. Valpas and P. K. Heinonen (2014).
“Quality of life and pelvic floor dysfunction symptoms after
hysterectomy with or without pelvic organ prolapse.” Eur J
Obstet Gynecol Reprod Biol 182C: 16-21.

Jimenez, D., J. de Miguel-Diez, R. Guijarro, J. Trujillo-Santos,
R. Otero, R. Barba, A. Muriel, G. Meyer, R. D. Yusen, M.
Monreal and R. Investigators (2016). “Trends in the
Management and Outcomes of Acute Pulmonary Embolism:
Analysis From the RIETE Registry.” J Am Coll Cardiol 67(2):
162-170.

Kahn, M. A. and S. L. Stanton (1997). “Posterior colporrhaphy:
its effects on bowel and sexual function.” Br J Obstet Gynaecol
104(1): 82-86.

Kwon, C. H., R. P. Goldberg, S. Koduri and P. K. Sand (2002).
“The use of intraoperative cystoscopy in major vaginal and
urogynecologic surgeries.” Am J Obstet Gynecol 187(6): 1466-
1471; discussion 1471-1462.

Maher, C. F., B.; Baessler, K.; Schmid, C. (2013). Surgical
management of pelvic organ prolapse in women. The Cochrane
Library, The Cochrane Collaboration.

Meschia, M., P. Pifarotti, F. Bernasconi, F. Magatti, D. Riva and
E. Kocjancic (2007). “Porcine skin collagen implants to prevent
anterior vaginal wall prolapse recurrence: a multicenter,
randomized study.” J Urol 177(1): 192-195.

Royal College of Anaesthetists (2015). Information leaflets.
[online] Available at: http://www.rcoa.ac.uk/node/3324.


Sung, V. W., C. R. Rardin, C. A. Raker, C. A. LaSala and D. L.
Myers (2012). “Changes in bowel symptoms 1 year after
rectocele repair.” Am J Obstet Gynecol 207(5): 423 e421-425.

van Dam, J. H., W. M. Huisman, W. C. Hop and W. R.
Schouten (2000). “Fecal continence after rectocele repair: a
prospective study.” Int J Colorectal Dis 15(1): 54-57.

Weber, A. M., M. D. Walters, M. R. Piedmonte and L. A. Ballard
(2001). “Anterior colporrhaphy: a randomized trial of three
surgical techniques.” Am J Obstet Gynecol 185(6): 1299-1304;
discussion 1304-1296.

13 Contact details

Urogynaecology nursing team
(For medical problems and questions only)
Direct line: 020 3447 6547

Mobile: 07951 674140
Fax:
Email:
020 3447 6590
urogynaecology@uclh.nhs.uk

 

Gynaecology outpatient appointments


(Contact for outpatient clinic appointments only)
Direct line: 020 3447 9411
Fax: 020 3447 6590

Preoperative Assessment Clinic (PAC)
(Contact for questions about PAC only)
Direct line: 020 3447 3167
Fax: 020 3383 3415

Gynaecology Admissions
(Contact for surgery dates and scheduling only)
Direct line: 020 3447 2504

Urogynaecology secretary
Direct line: 020 3447 2516

Fax: 020 3447 9775
University College Hospital
Switchboard: 020 3456 7890
Website: www.uclh.nhs.uk

 

14 How to find us


The Urogynaecology and Pelvic Floor Unit
Clinic 2, Lower Ground Floor
Elizabeth Garrett Anderson (EGA) Wing
University College Hospital
25 Grafton Way
London
WC1E 6DB