What is colporrhaphy?
Colporrhaphy is a surgical procedure used for people with vaginal wall prolapse, a type of pelvic organ prolapse (POP). With pelvic organ prolapse, the organs inside your pelvis sag because the supporting muscles and tissues in your vaginal wall have weakened. Colporrhaphy strengthens these muscles and tissues to help them better support pelvic organs, like the bladder and rectum.
Colporrhaphy is a minimally invasive surgery. During a colporrhaphy, your surgeon strengthens your vaginal walls, helping alleviate symptoms such as difficulty with bowel movements, problems urinating, discomfort and other symptoms that may be impacting your life.
Types of colporrhaphy
There are two types of colporrhaphy, and your provider may perform one or both, often in combination with other procedures, to repair vaginal wall defects.
-
Anterior colporrhaphy (cystocele repair)
Anterior colporrhaphy is used to treat anterior (front) vaginal wall prolapse, or cystocele. A cystocele occurs when the front wall of the vagina weakens, and your bladder or urethra drops into the vagina. Anterior repair allows your surgeon to move the bladder back into place and prevent urinary incontinence, a common symptom of cystocele.
-
Posterior colporrhaphy (rectocele repair)
A posterior colporrhaphy is used to treat posterior (back) vaginal wall prolapse, or rectocele. A rectocele affects the back wall of the vagina, where weak muscles allow the rectum to drop or fall into the vagina. Posterior repair helps strengthen the muscles that hold the rectum in place, preventing constipation and other bowel problems.
Why might I need colporrhaphy surgery?
Your OBGYN or urogynecologist may recommend a colporrhaphy if your prolapse symptoms significantly impact your quality of life. Vaginal wall prolapse can lead to symptoms such as bladder or bowel control problems and pain during sex (dyspareunia).
Colporrhaphy is also a next-step treatment if nonsurgical options, such as pelvic floor physical therapy, estrogen creams and pessaries, haven’t helped your symptoms.
If you still want to have children, talk to your healthcare team about the pros and cons of colporrhaphy. Having a vaginal birth after the procedure may cause a return of your symptoms. But a cesarean section may be an option depending on your current health and other factors.
How to prepare for colporrhaphy
In the days or weeks before your surgery, you will have medical appointments that include a pelvic exam, so your provider knows where the weaknesses are in your vaginal walls and can plan your surgery.
Colporrhaphy is less invasive than other types of pelvic organ prolapse repair, but it is still a major surgery. Depending on your prolapse, you may have an outpatient surgery when you can go home the same day, or stay in the hospital overnight. In both cases, arrange for someone to drive you to the facility on the day of your surgery and home.
Ask you doctor
As you prepare for the procedure, talk to your surgical team about the following:
- Whether you need to take off work and, if so, for how long
- Whether you will have general anesthesia, where you’ll be asleep, or local anesthesia, where you will be awake but unable to feel anything
- Whether you need to stop or start taking medications in the days leading up to your procedure
- How long you can expect full recovery to take
The colporrhaphy procedure
During a colporrhaphy, your surgeons will move your bladder or rectum back into place and strengthen the vaginal walls to prevent the organs from prolapsing again. The length of time of the procedure will depend on how complex the surgery is.
Before the procedure
Your medical team will tell you when to arrive for your procedure. They may also ask you to avoid eating or drinking for six to 12 hours beforehand. You may receive a single-dose antibiotic on the day of the procedure to reduce your risk of infection.
During the procedure
A colporrhaphy is performed while lying on a table, on your back with your knees up and bent at a 90-degree angle. You’ll have padded footrests where you can rest your legs to stay comfortable throughout the procedure.
The procedure will begin with you receiving anesthesia. Once it has taken effect, your surgeon will:
- Insert a speculum to open your vagina and allow access to the vaginal walls
- Make an incision along the front or back wall of your vagina
- Separate the vaginal wall from the weak tissue that’s allowing the bladder or rectum to prolapse
- Repair the weak tissue with stitches that secure it in the correct position
- Potentially reinforce the weakened area with a patch made of tissue or mesh
- Stitch the vaginal wall back together with sutures that will dissolve over the following months
In some cases, your surgeon may also place a pack into your vagina to reduce bleeding and bruising as you recover, and you may receive a catheter, a flexible tube used to empty your bladder.
The length of your procedure depends on how complex a repair is. Some take as little as 30 minutes.
After the procedure
After surgery, you’ll be given time to let the anesthesia wear off. The pack and catheter, if you received them, will be removed about 24 hours after surgery.
For about a month to six weeks after surgery, you may have some vaginal discharge, resulting from the sutures breaking down and getting absorbed by your body. You may also notice blood in your discharge. This is normal and may appear for a few days or up to a week after your procedure.
Your care team may also give you instructions to follow for the six to eight weeks after your procedure, such as:
- Avoiding sex, heavy lifting and intense exercise
- Showering, instead of taking baths
- Taking a stool softener or laxative, eating a high-fiber diet and drinking plenty of water to reduce straining during bowel movements (you may need to do this for up to three months)
- Using pads instead of tampons
Full recovery from colporrhaphy may take up to three months.
Understanding the outcomes
Many people experience relief from their symptoms after colporrhaphy, and the results generally last for years.
Rectocele repair has high success rates. However, there is a chance that prolapse can return, particularly with anterior repair. You may also experience weakening in another area of the vaginal wall and need another vaginal prolapse repair procedure.
Talk to your provider if you experience side effects, including pain during sex and urinary incontinence, that can occur after colporrhaphy. Your provider can give you medications. You may also benefit from pelvic floor physical therapy and other treatments to help you manage these new conditions.