Colporrhaphy

What is colporrhaphy?

Colporrhaphy (pronounced kaal-PAW-ruh-fee) is a surgery that fixes weaknesses in your vaginal walls. It’s a treatment for pelvic organ prolapse (POP). Your healthcare provider does this surgery through your vagina.

With POP, the organs inside your pelvis — like your bladder or rectum — droop. This happens because the supporting muscles and ligaments in your vaginal wall are too weak to hold them in place. Colporrhaphy repairs these vaginal tissues so they can support your pelvic organs.

The two types of colporrhaphy are:

• Anterior colporrhaphy (cystocele repair): This repairs the muscles and tissues in the front wall of your vagina. It treats anterior wall prolapse (cystocele).
• Posterior colporrhaphy (rectocele repair): This repairs the muscles in the back of your vagina. It treats posterior wall prolapse (rectocele).

Colporrhaphy can help relieve POP symptoms like a vaginal bulge, pressure and difficulty controlling when you pee or poop (incontinence).

How should I prepare for this procedure?

Before the procedure, your healthcare provider will:

• Review your medical history and symptoms: Your symptoms can provide clues that help your provider pinpoint the exact spot where your muscles need help.
• Do a pelvic exam: Your provider does an exam to look for prolapse. This often includes using a speculum exam to look at the walls of your vagina. They may also insert a finger into your rectum to do a rectal exam.
• Prescribe antibiotics to reduce the risk of infection during surgery: Often, you take a single-dose antibiotic, usually given through an IV, the day of your surgery.

If you’ve gone through menopause, your provider may prescribe vaginal estrogen before surgery. Estrogen may increase the thickness of your vaginal tissue and improve its overall health. This may help with healing after surgery.

How is colporrhaphy performed?

In general, you can expect the following during a colporrhaphy:

1. You’ll lie on a table with built-in, padded footrests to support your legs. You’ll lie on your back with your legs lifted and your knees bent at about 90 degrees. The footrests will support your calves.
2. You’ll get either general anesthesia (you’re asleep) or regional anesthesia (you’re numb but awake).
3. Your provider will insert a bladder catheter to catch your pee during the procedure.
4. Your provider will make a cut to expose the muscles and tissues in your vaginal wall.
5. They’ll make small, precise cuts along the front wall or back wall of your vagina to access the weakened parts of your vaginal wall.
6. They’ll use stitches to attach the strong parts of your vaginal wall together.
7. They’ll close the incision with dissolvable stitches.

How long does this procedure take?

Surgery usually takes about 30 minutes. But it may take longer if your healthcare provider needs to repair more tissue. Your provider will give you a better idea of what to expect.

What are the potential benefits and risks of this procedure?

The success rate for anterior colporrhaphy is mixed. Your vagina’s front wall is the most common site for an organ to slip out of place, even after surgery. Still, colporrhaphy often improves symptoms — even if your walls weaken a bit after surgery.

You can have penetrative sex once you’ve healed from colporrhaphy. With some other types of POP surgeries, like colpocleisis, this isn’t possible.

Risks and complications

Although complications with colporrhaphy are rare, any surgery poses risks.

Complications may include:

• Urinary tract infections (UTIs) — most common
• Constipation
• Excessive bleeding
• Painful intercourse
• Reaction to the anesthesia
• Infection at the wound site
• Injury to your pelvic organs
• Urinary and/or fecal incontinence

What happens after this procedure?

You’ll usually be able to go home the same day of your surgery. Following surgery:

• Your provider will check to see whether you can pee on your own or need a short-term catheter.
• You may need a stool softener or gentle laxative so you can poop without placing strain on healing muscle and tissue.
• Your provider may prescribe vaginal estrogen if you’re post-menopausal. Estrogen may speed healing and reduce your risk of a UTI after surgery.

You may experience common side effects, like:

• Trouble emptying your bladder completely (urinary retention) for a few days following surgery
• Bloody vaginal discharge for a few days to weeks following surgery
• Vaginal discharge for a few weeks following surgery
• Vaginal pain, which should go away within four to six weeks

Your provider may recommend a checkup at four to six weeks after surgery.

What is the recovery time?

In most cases, you should be fully healed within three months. In the meantime, your provider may advise you to:

• Take stool softeners (for up to three months).
• Avoid straining while pooping (for at least six weeks).
• Ease yourself into your daily activities by listening to your body.
• Shower instead of taking baths (for at least six weeks).
• Avoid inserting tampons into your vagina, douching or having intercourse (for six weeks).

You can walk immediately after surgery. This helps with healing. You may drive if you’re not on any narcotic pain medications and your pain level is well managed. Depending on the nature of your work and how extensive the surgery is, you may be able to return to work within a few weeks.