Vaginal repair surgery (colporrhaphy)

Published by Bupa's Health Information Team, September 2010.

This factsheet is for women who are having 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's also known as colporrhaphy.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About vaginal repair

The muscles and the ligaments that support your vagina and womb can become over stretched and weakened, causing them to drop down.

Your bladder and bowel, which are nearby, can also drop down and bulge into your vagina. This is known as a prolapse and can be repaired using vaginal repair surgery.

Pregnancy and childbirth are common causes of prolapse. Being very overweight, having constipation, or a cough that has lasted a long time, or going through the menopause can also cause a prolapse. A prolapse can lead to problems passing urine and opening your bowels. It can also make having sex difficult.

A vaginal repair operation helps to strengthen your vaginal walls and ease your symptoms.

What are the alternatives?

If your prolapse is mild, pelvic floor muscle exercises and vaginal pessaries may help control your symptoms. However, if your prolapse is more severe, you may need to have surgery. Your surgeon will discuss your options with you.

Preparing for vaginal repair surgery

Your surgeon will explain how to prepare for your vaginal repair surgery.

You will usually need to stay in hospital for between one and six days, depending on the type of surgery you have and how well you recover. The operation may be performed under general anaesthesia, which means you will be asleep during the procedure, or under local anaesthesia which completely blocks pain from the area and you will stay awake during the operation.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.

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

What happens during vaginal repair surgery

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 allows your anaesthetist to give you the medicines that will put you to sleep and prevent you being sick. You may also have a drip inserted into the cannula to give you fluids. The operation takes about an hour.

The type of surgery you have will depend on where your prolapse is and how severe it is. Your surgeon will usually repair your vaginal wall through your vagina, so all your stitches will be inside your vagina and you shouldn't have a scar on your abdomen (tummy).

During the operation, your surgeon may remove some of the stretched muscles and ligaments. He or she may also tighten some of the supporting tissues and stitch a mesh over the repaired wall if this has been discussed with you before surgery. This helps to give extra support to your vaginal wall. Your surgeon will discuss the benefits, risks and complications of inserting a mesh before your operation. The stitches your surgeon uses are dissolvable and won't need to be taken out after the operation.

What to expect afterwards

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

You may need pain relief to help with any discomfort as the anaesthetic wears off. You may be offered patient controlled analgesia (PCA) immediately after your operation. This is a pump connected to your cannula that contains strong painkillers. You can control how much painkiller you have by pushing a button when you need it. When your pain eases, you may be offered painkilling tablets or suppositories instead.

You may have a catheter to drain urine from your bladder into a bag. You may also have a gauze dressing packed into your vagina to help prevent bleeding. Both of these are usually removed one to two days after your operation.

Your drip and cannula will be removed when you're able to drink enough fluids and when you no longer need medicines through the cannula. You may have some vaginal bleeding, which is usually similar to a light period. If you have heavy bleeding, tell your nurse or doctor straight away.

Your nurse will give you advice about getting out of bed, having a bath or shower, and eating and drinking. You may see a physiotherapist who will give you exercises to do that may help speed up your recovery.

You may find that you don't open your bowels for a few days after your operation. If this happens, talk to your nurse for advice. Try not to strain when you go to the toilet as this can stretch your healing wounds.

Your surgeon will visit you before you go home to assess your progress and answer any questions that you have. You will need to arrange for someone to drive you home. Try and have a friend or relative stay with you for the first 24 hours after your vaginal repair surgery.

Recovering from vaginal repair surgery

It usually takes about 12 weeks to make a full recovery from vaginal repair surgery, but this can vary, so it's important to follow your surgeon's advice.

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.

Don't drive until you're confident that you could perform an emergency stop without discomfort.

You may have some blood-stained vaginal discharge for about six weeks after surgery. If the discharge becomes smelly or changes in colour, or if you have pain and feel unwell, contact your doctor for advice as you may have an infection. Use sanitary towels rather than tampons to help reduce the risk of infection.

Take things gently for a few days after returning home. Don't lift anything heavy or do strenuous exercise until you have made a full recovery.

You should wait six weeks before having sexual intercourse.

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

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. You will have some pain and discomfort in your abdomen and vagina.

You will also have some vaginal bleeding, similar in amount to a normal period. This may last for up to six weeks.

Complications

Complications are when problems occur during or after the operation. 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 can include:

• infection - antibiotics can help treat any infection
• damage to the womb, vagina or cervix, and/or part of the bladder or bowel - you may need more surgery to repair the damage
• problems passing urine - this usually improves without further treatment
• mesh-related complications - your surgeon will discuss these with you depending on the type of mesh that may be inserted

Vaginal repair surgery doesn't always repair a prolapse completely and some women find that the prolapse comes back. If this happens, you may need more surgery. Vaginal repair surgery may not ease any bladder and bowel symptoms or resolve sexual problems that you had before surgery.

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

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.