Anterior and Posterior Colporrhaphy

Anterior and Posterior Colporrhaphy Surgeries

Anterior or posterior colporrhaphy is surgery to fix a prolapse of organs in the genital tract. Prolapse is a condition in which an organ bulges or drops down from its normal position. Organs that commonly prolapse include the rectum, bladder, vagina, and uterus. Prolapse can affect a single organ or several organs at the same time.

You may need this surgery if you have a severe prolapse that causes symptoms that interfere with your daily life and cannot be corrected with other treatments. Prolapse often worsens when women stop having their monthly periods (menopause) because estrogen loss weakens the muscles and tissues in the genital tract. Prolapse can also happen when the organs are damaged or weakened. This commonly happens after childbirth and as a result of aging.

The type of colporrhaphy done depends on the type of genital prolapse. Types of genital prolapse include the following:

• Cystocele. This is a prolapse of the bladder and the upper part of the front (anterior) wall of the vagina.
• Rectocele. This is a prolapse of the rectum and the lower part of the back (posterior) wall of the vagina.
• Enterocele. This is a prolapse of the small intestine. It appears as a bulge under the neck of the uterus at the top of the back wall of the vagina.
• Procidentia. This is a complete prolapse of the uterus and the cervix. The prolapse can be seen and felt coming out of the vagina.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Smoking history or history of alcohol use.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Problems urinating.
• Incontinence.
• Nerve damage.
• Painful sex.
• Constipation.
• A blood clot that travels to your lungs.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotics to help prevent infection.
• You may be instructed to use estrogen cream in your vagina to help prevent complications and promote healing.
• Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes, for at least 2 weeks before the procedure. If you need help quitting, ask your health care provider.
• Plan to have someone take you home from the hospital. Also, arrange for someone to help you with activities during recovery.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• You may be given antibiotics through your IV.
• You will lie down on the operating table with your feet in stirrups.
• A small, thin tube (catheter) will be inserted through your urethra into your bladder to drain urine during surgery and recovery.
• An instrument (vaginal speculum) will be used to hold your vagina open.
• Your health care provider will perform the procedure according to the type of repair you require:

Anterior repair

• An incision will be made in the midline section of the front part of the vaginal wall.
• A triangular-shaped piece of vaginal tissue will be removed.
• The stronger, healthier tissue will be sewn together in order to support the bladder.
• These incisions may be closed with stitches (sutures).
• Gauze packing will be placed inside your vagina.

Posterior repair

• An incision will be made midline on the back wall of the vagina.
• A triangular portion of vaginal skin will be removed to expose the muscle.
• Excess tissue will be removed, and stronger, healthier muscle and ligament tissue will be sewn together to support the rectum.
• These incisions may be closed with stitches (sutures).
• Gauze packing will be placed inside your vagina.

Anterior and posterior repair

• Both procedures will be done during the same surgery.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will be given pain medicine as needed.
• You will have a small tube in place to drain your bladder (urinary catheter). This will be in place until your bladder is working properly on its own.
• You may have a gauze packing in your vagina for a few days to prevent bleeding.
• You will start on a liquid diet and slowly move to a regular diet.
• You will be encouraged to get up and walk as soon as you are able.
• You may need to wear compression stockings. They help prevent blood clots and reduce swelling in your legs.
• Do notdrive for 24 hours if you were given a sedative.

Summary

• Anterior or posterior colporrhaphy is surgery to fix a prolapse of organs in the genital tract.
• The type of repair done depends on the type of prolapse that is present.
• Follow instructions from your health care provider about eating and drinking before the procedure.
• You will be given a general anesthetic to make you fall asleep during the procedure.

Anterior and Posterior Colporrhaphy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain in the surgical area.
• Vaginal spotting and discharge. You will need to use a sanitary pad during this time.
• Fatigue.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before touching the incision area. If soap and water are not available, use hand sanitizer.
  • Clean your incision as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Check your incision every day to make sure the incision area is not separating or opening up.
• Do nottake baths, swim, or use a hot tub until your health care provider approves. You may shower.
• Keep the area between your vagina and rectum (perineal area) clean and dry. Make sure you clean the area after every bowel movement and each time you urinate.

Ask your health care provider if you can take a sitz bath or sit in a tub of clean, warm water.

Activity

• Take frequent, short walks followed by rest periods throughout the day.
• Avoid activities that take a lot of effort (are strenuous).
• Do notlift anything that is heavier than 10 lb (4.5 kg), or the limit that your health care provider tells you, until he or she says that it is safe. Avoid pushing or pulling motions.
• Avoid standing for long periods of time.
• Do notdouche, use tampons, or have sex until your health care provider says it is okay.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do notdrive until your health care provider approves.

To prevent constipation

To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:

• Take over-the-counter or prescription medicines.
• Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
• Drink enough fluid to keep your urine clear or pale yellow.
• Limit foods that are high in fat and processed sugars, such as fried and sweet foods.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• You may be instructed to do pelvic floor exercises (kegels) as told by your health care provider.
• Do notdrive or use heavy machinery while taking prescription pain medicine.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Medicine does not help your pain.
• You have frequent or urgent urination, or you are unable to completely empty your bladder.
• You feel a burning sensation when urinating.
• You have pus or a bad smell coming from your vaginal area.
• You have redness, swelling, or increasing pain in the vaginal area.

Get help right away if:

• You have increased bleeding from the vaginal area.
• You cannot urinate.
• You have a fever or chills.
• Your incision separates or opens.
• You have trouble breathing.

Summary

• After the procedure, it is common to have pain, fatigue, spotting, and discharge from the vagina.
• Keep the area between your vagina and rectum (perineal area) clean and dry. Make sure you clean the area after every bowel movement and each time you urinate.
• Follow instructions from your health care provider about any activity restrictions after the procedure.

Anterior and Posterior Colporrhaphy and Sling Procedure

Anterior and posterior colporrhaphy and sling procedure are combined surgical procedures that treat weakness in the front (anterior) or back (posterior) walls of your vagina. When weakness occurs in the anterior wall of the vagina, the bladder can bulge into the vagina (cystocele). When weakness occurs in the posterior wall of the vagina, the rectum can bulge into the vagina (rectocele). This condition is called pelvic organ prolapse.

In this procedure, a surgical mesh sling will be placed around the tube that empties urine from your bladder (urethra). The sling will hold your urethra and bladder in place to prevent urine leakage (incontinence). This surgery is usually done through incisions in your vagina. It can also be done through incisions in your lower abdominal or groin area.

You may need this surgery if pelvic organ prolapse causes symptoms that interfere with your daily life and cannot be corrected with other treatments.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or dyes.
• Damage to other structures or organs.
• Incontinence.
• A blood clot that travels to your lung.
• Nerve damage.
• Painful sex.
• Urine leakage into the vagina.
• Constipation.
• Tissue damage from the sling over time. The sling may need to be removed.

What happens before the procedure?

Staying hydrated

• Follow instructions from your health care provider about hydration, which may include:
  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

• Follow instructions from your health care provider about eating and drinking, which may include:
  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotics to help prevent infection.
• You may be instructed to use estrogen cream in your vagina to help prevent complications and promote healing.
• Plan to have someone take you home from the hospital.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube may be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• You may be given antibiotics through your IV.
• You will lie down on the operating table with your feet in stirrups.
• A small, thin tube (catheter) will be inserted through your urethra into your bladder to drain urine during surgery and recovery.
• An instrument (vaginal speculum) will be used to hold your vagina open.
• To correct a cystocele:
  • An incision will be made in the front wall of your vagina.
  • Your bladder will be placed back into normal position.
  • Weak or excess vaginal lining may be removed.
  • The front wall of your vagina will be closed with stitches (sutures).
• To correct a rectocele:
  • An incision will be made in the back wall of your vagina.
  • Your rectum will be placed back into normal position.
  • Weak or excess vaginal lining may be removed.
  • The back wall of your vagina will be closed with sutures.
• To place a sling:
  • Small incisions may be made inside your vagina or in your lower abdominal or groin area to insert the sling.
  • The sling will be placed around your urethra and attached to strong tissues inside your abdomen.
  • These incisions may be closed with sutures or glue.
• Gauze packing will be placed inside your vagina.
• The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will be given pain medicine as needed.
• You will start on a liquid diet and move to a regular diet.
• You will be encouraged to get up and walk as soon as you are able.
• You may need to wear compression stockings. They help prevent blood clots and reduce swelling in your legs.
• Your IV, urinary catheter, and vaginal packing may be removed before you go home.
• Do not drive for 24 hours if you were given a sedative.

Summary

• Anterior and posterior colporrhaphy and sling procedure are combined surgical procedures that treat weakness in the anterior or posteriorwalls of your vagina.
• Plan to have someone take you home from the hospital or clinic.
• After the procedure, you will be encouraged to start drinking and eating and be up and walking as soon as you are able.
• The IV, urinary catheter, and vaginal packing may be removed before you go home.

Anterior and Posterior Colporrhaphy and Sling Procedure, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain in the surgical area.
• Vaginal discharge. You will need to use a sanitary pad during this time.
• Fatigue.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before touching the incision area. If soap and water are not available, use hand sanitizer.
  • Clean your incision as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Check your incision every day to make sure the incision area is not separating or opening.
• Do nottake baths, swim, or use a hot tub until your health care provider approves. You may shower.
• Keep the area between your vagina and rectum (perineal area) clean and dry. Make sure you clean the area after each bowel movement and each time you urinate.

Ask your health care provider if you can take a sitz bath or sit in a tub of clean, warm water.

Activity

• Do gentle, daily activity as told by your health care provider. You may be told to take short walks every day and go farther each time. Ask your health care provider what activities are safe for you.
• Limit stair climbing to once or twice a day in the first week, then slowly increase this activity.
• Do notlift anything that is heavier than 10 lbs. (4.5 kg), or the limit that your health care provider tells you, until he or she says that it is safe. Avoid pushing or pulling motions.
• Avoid standing for long periods of time.
• Do notdouche, use tampons, or have sex until your health care provider says it is okay.
• Do not drive or use heavy machinery while taking prescription pain medicine.

To prevent constipation

• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.

General instructions

• You may be instructed to do pelvic floor exercises (kegels) as told by your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Medicine does not help your pain.
• You have frequent or urgent urination, or you are unable to completely empty your bladder.
• You feel a burning sensation when urinating.
• You have fluid or blood coming from your incision.
• You have pus or a bad smell coming from the incision.
• Your incision feels warm to the touch.
• You have redness, swelling, or pain around your incision.

Get help right away if:

• You have a fever or chills.
• Your incision separates or opens.
• You cannot urinate.
• You have trouble breathing.

Summary

• After the procedure, it is common to have pain, fatigue, and discharge from the vagina.
• Keep the area between your vagina and rectum (perineal area) clean and dry. Make sure you clean the area after each bowel movement and each time you urinate.
• Follow instructions from your health care provider on any activity restrictions after the procedure.