Colporrhaphy

What is colporrhaphy?

Colporrhaphy is a surgery used to fix weaknesses in your vaginal walls. It's a treatment for pelvic organ prolapse (POP). With POP, the organs inside your pelvis droop because the supporting muscles and tissues in your vaginal wall have become too weak to hold the organs in place. Colporrhaphy strengthens these muscles and tissues so that they can support pelvic organs like your bladder and rectum.

There are two types of colporrhaphy. Your provider may perform one or both in combination with other procedures to fix vaginal wall defects.

• Anterior colporrhaphy (aka cystocele repair): Weakened muscles in between your bladder and vagina may cause your bladder to droop onto your vagina’s front wall. This is a specific type of POP called an anterior wall prolapse. Anterior colporrhaphy tightens the muscles in the front wall that hold your bladder in place.
• Posterior colporrhaphy (aka rectocele repair): Weakened muscles in between your rectum and vagina may cause your rectum to droop onto your vagina's back wall. This is a specific type of POP called posterior wall prolapse. Posterior colporrhaphy tightens the muscles in the back wall that hold your rectum in place.

Is colporrhaphy major surgery?

Yes. There are two major types of surgery to treat POP: obliterative (less invasive) and reconstructive surgery (more invasive). Colporrhaphy is a reconstructive surgery where your provider performs the procedure through your vagina. Colporrhaphy is less invasive than other types of reconstructive surgeries that involve opening your abdomen to access your pelvic organs, but it's still major surgery.

Why is this treatment done?

Colporrhaphy can relieve POP symptoms that interfere with your well-being. POP symptoms like urinary or fecal incontinence (difficulty controlling when you pee or poop) and painful intercourse can reduce your quality of life. Colporrhaphy can fix the structural issues in your pelvis so that you don't have to live with the symptoms these issues cause.

Who needs to have this treatment?

You may be a candidate for colporrhaphy if:

• Conservative treatments haven't improved your POP symptoms. Non-invasive treatments to strengthen your pelvic floor muscles or hold your organs in place are the first line of treatment for POP. These treatments include pelvic floor exercises (Kegels), devices like pessaries, and hormone therapy.
• You're experiencing bothersome symptoms. Many people with POP don't experience symptoms that disrupt their lives. Since any surgery involves risks (including colporrhaphy), it may not be worth the risk of complications if POP isn't causing you discomfort.
• You don't plan to have children. Having a child after colporrhaphy may increase the risk of structural issues and symptoms returning. It may be best to wait on surgery until you've finished having children.

What is involved with anterior and posterior colporrhaphy?

Both procedures involve your provider putting sagging organs back into place. Then, they reinforce the weakened muscles and tissues that hold these organs in place with dissolvable sutures. The reinforcements keep your vaginal wall tight and your organs in position.

What happens before colporrhaphy?

Your provider will review the risks and benefits of colporrhaphy with you so that you have all the information you need to decide if this surgery is right for you.

Before the procedure, your 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 to be reinforced. This information allows your provider to perform surgical techniques that target particular areas of your vaginal wall during surgery.
• Perform a bimanual pelvic exam. Your provider will insert two fingers inside your vagina while applying pressure to your abdomen. This technique allows them to feel for sagging pelvic organs and identify weak spots in your vaginal wall.
• Order imaging or lab work, as needed. Often, additional imaging isn't needed. But your provider may order an MRI to take a closer look for defects in your pelvic floor muscles.
• Prescribe antibiotics to reduce the risk of infection during surgery. Often, you can take a single-dose antibiotic the day of your surgery.

If you've gone through menopause, your provider may prescribe topical or vaginal estrogen before surgery. Data suggests that estrogen may increase the thickness of your vaginal tissue so that it's easier to work with during surgery.

What happens during colporrhaphy?

First, your healthcare provider will give you anesthesia to keep you comfortable. Next, you'll get positioned on a table with built-in padded footrests to support your legs. You'll lie on your back with your legs lifted, knees bent at about 90 degrees, and your calves supported in the footrests. This position, called the dorsal lithotomy position, allows your provider to easily access your vagina and the tissue between your vagina and anus (perineum).

Once you're in a comfortable position, your provider will:

1. Administer either general anesthesia (you're asleep) or regional anesthesia (you're numb but awake) and insert a bladder catheter to catch your pee during the procedure.
2. Widen your vagina with a tool called a speculum so that it's easier to inspect your vaginal walls.
3. Make a vertical incision (cut) to expose the muscles and tissues in your vaginal wall.
4. Make small, precise cuts along the top wall of your vagina (for anterior colporrhaphy) or the back wall of your vagina (posterior colporrhaphy) to access the weakened parts of your vaginal wall.
5. Suture the strong parts of your vaginal wall together.
6. Close the incision with dissolvable stitches.

How long does colporrhaphy surgery take?

Surgery may take as little as 30 minutes if the weakened muscles are confined to a small section. Colporrhaphy may take longer if larger areas of your vaginal wall need repairing.

What happens after colporrhaphy?

Depending on the extent of your vaginal wall repairs, you may be able to go home the day of your surgery, or you may need to stay in the hospital overnight.

Following surgery:

• Your provider may insert a pack into your vagina to absorb your bleeding. It can usually be removed after 24 hours.
• Your provider will check to see whether you can pee on your own or if you need a catheter. Most catheters can be removed within 48 hours following colporrhaphy.
• You may be placed on a stool softener or gentle laxative so you can poop without placing strain on healing muscle and tissue.
• You may be prescribed vaginal estrogen if you're post-menopausal. Data suggests that estrogen may speed healing and reduce your risk of a urinary tract infection (UTI) after surgery.

You may experience common side effects:

• You may have trouble emptying your bladder completely (urinary retention) for a few days following surgery.
• You may notice bloody vaginal discharge for a few days following surgery.
• You may notice a creamy vaginal discharge for a few weeks following surgery. The discharge is a sign of your body absorbing the sutures.
• You may experience vaginal pain. It should go away within four to six weeks.

Your provider may recommend a check-up at four to six weeks after surgery. Follow your provider's instructions on when to schedule follow-up appointments.

What are the advantages of this procedure?

Colporrhaphy can relieve your POP symptoms without traditional surgery that requires a large incision into your abdomen. With posterior colporrhaphy, the repositioned organs often stay in place after surgery and the symptoms don't return. The success rate for anterior colporrhaphy is more 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 for people whose walls weaken a bit after surgery.

Unlike some treatments used to treat pelvic organ prolapse, like colpocleisis, you can have intercourse following colporrhaphy once you’ve healed from surgery.

What are the risks or complications of colporrhaphy?

Although complications with colporrhaphy are rare, any surgery poses risks. Be sure to discuss risk factors, like your general health and preexisting health conditions, with your provider before surgery.

Complications include:

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

Your surgeon may recommend mesh to make your repair more durable. There's a small risk of mesh exposure with these procedures. In 2019, the FDA banned a specific type of mesh — and this mesh is no longer used. The mesh available now has been further studied and shown to be safe for POP repairs.

Talk to your provider about potential complications if you've previously had a colporrhaphy that involved mesh.

What is the recovery time?

Within three months, you should be fully healed from your colporrhaphy, depending on how extensive your repairs were. In the meantime, your provider may advise you to:

• Take stool softeners (for up to three months).
• Avoid straining during bowel movements (for at least six weeks after surgery).
• Avoid lifting objects heavier than five pounds and engaging in strenuous exercises, like jogging or weight lifting (for at least six weeks after surgery).
• Shower instead of taking baths (for at least six weeks after surgery).
• Avoid inserting tampons into your vagina, douching or having intercourse (for six to eight weeks after surgery).

When can I go back to work/school/drive/eat?

Within three to four weeks, you should be able to go for walks and drive again, and you may be able to return to work. Your timetable for getting back into your routine depends on how extensive your surgery was and how physically strenuous your work is. Share these details about how physically demanding your job is with your provider when you’re discussing your recovery plan.

A note from Cleveland Clinic

You don’t have to live with unpleasant symptoms related to pelvic organ prolapse (POP). With colporrhaphy, your provider can strengthen your vaginal walls by performing surgery through your vagina. It’s much simpler than reconstructive surgeries for POP that require a large incision into your abdomen. Discuss the pros and cons of colporrhaphy with your provider to determine if it’s the right treatment for you.