Prolapse of the front wall of the vagina, also known as the anterior, occurs due to a weakening of the layer of tissue (the fascia) dividing the bladder and the vagina. Symptoms include a feeling of fullness or dragging in the vagina and an uncomfortable bulge going down below the opening of the vagina.
Some people may also experience a difficulty or urgency when trying to pass urine, or a more frequent need to go to the toilet.
Anterior wall prolapse is also called cystocoele.
Anterior repair / Bladder Repair
Also known as colporrhaphy, this procedure is used to reinforce and repair the fascial support layer which lies between the vagina and bladder. The purpose of surgery is to provide relief for the symptoms associated with prolapse, as well as to improve the functioning of the bladder.
What happens during surgery?
The procedure is carried out under local or general anaesthetic, depending on the type performed and the individual patient. There are several different methods of performing an anterior repair, but here we outline the most common type.
First, an incision is made in the vagina, along the middle of the front wall which begins at the entrance of the vagina and ends near the top. The skin is separated from the underlying fascial layer and the weakened tissue is repaired with stitches which can absorb into the body over several weeks or months. The time taken to fully absorb will vary depending on the type/material used.
In some cases, there might be an excess of vaginal skin which needs to be removed. This will be closed up with absorbable stitches which take between 4-6 weeks to dissolve.
Sometimes, a procedure called a cystoscopy is carried out to check that the bladder is normal and that it has not be harmed during the operation.
The surgeon might place a pack into the vagina, along with a catheter in the bladder. These are normally taken out within 48 hours and are used to prevent excessive bruising and bleeding of the vagina.
This surgery is often carried out with other repair procedures, such as the vaginal hysterectomy, posterior vaginal wall repair and treatment for incontinence.
Patients will wake in hospital with a drip attached to them and sometimes a catheter into their bladder. A pack to stop vaginal bleeding might also be present. All of these will be removed within 48 hours following the surgery.
A creamy discharge is normal for many patients after the procedure, and this can last for around 4-6 weeks. Once the stitches begin to absorb into the body, the discharge will lessen. However, if you notice a strong smell, consult your doctor immediately. A thin, brownish blood is also normal for about a week or so after the operation.
Patients should avoid strenuous activities, such as exercise, lifting, coughing, constipation or straining during the early post-surgery period. Your doctor can give you a more accurate idea of healing times, depending on the type of surgery you have had and your individual needs, though most patients are advised to have between 2-6 weeks off work. This, of course, depends upon the type of job you have and the severity of your surgery.
It is recommended that patients do not attempt to have sex for at least six weeks and only then until they feel ready to do so. Lubrication is commonly used to help ease the discomfort or difficultly when having sexual intercourse again following surgery.
Surgical success rates
The rate of success for an anterior wall repair surgery is between 70-90%. There might be a chance that prolapse can return in the future, or in another area of the vagina, in which case patients might need to undergo a repeat procedure.
There is always a risk of complication with any surgical procedure. Complications which can arise, include:
- Anaesthetic complications are very rare.
- Excessive bleeding which requires blood transfusion occurs in less than 1% of women after vaginal surgery.
- Post-operative infection in the vaginal or pelvic areas is rare.
- Infection of the bladder, known as cystitis, occurs in about 6% of women, but is more common in those who have a catheter inserted. Cystitis can be easily treated using antibiotics.
Complications which are specifically related to the anterior vaginal wall repair, are:
- Laxatives are prescribed to help with this and you should have a high-fibre diet as well as drinking lots of water.
- Painful intercourse, also known as dyspareunia, occurs in some women and is often unavoidable. However, a lot of women report a more comfortable sex life following prolapse repair surgery.
- Bladder or ureters damage is uncommon and, if it does occur, can be repaired with surgery.
- Stress Urinary Incontinence – which can occur after particularly large anterior vaginal wall repair surgeries.