Surgery for vaginal prolapse will be necessary for around 1 in 10 women following childbirth. Prolapse of the posterior, or back wall of the vagina, occurs because of a weakening of the fascia, which is the layer of tissue that divides the vagina and the lower section of the bowel, known as the rectum.
The weakening of this tissue often results in a bowel movement difficulties, as well as a dragging or full feeling and an uncomfortable bulge, which can extend down beyond the opening of the vagina. Other names for this particular problem are rectocoele and enterocoele.
The tissue between the anal and vaginal openings is called the perineal body, and its job is to also help keep the back wall of the vagina supported. This area is also commonly damaged after giving birth, causing tears or episiotomies, which often require surgery to repair.
Also referred to as posterior colporrhaphy, this surgery is used to repair and reinforce the facial support layer which is found between the vagina and rectum. The surgery which is used to repair the perineal body is called a perineorhaphy.
Why is this type of surgery carried out?
The purpose of this procedure is to give the patient relief from the symptoms of vaginal bulging and laxity, whilst also preserving or improving both the working of the bowels and sexual function.
What does surgery entail?
The surgery can be carried out under local or general aesthetic and this will be discussed with the patient prior. The procedure for posterior repair can be carried out in several different ways, but here we outline the most commonly used method.
First, an incision is made along the middle of the back wall of the vagina, which starts from the entrance of the vagina and goes through to the top of the vagina. After this, the skin of the vagina is separated from the underlying supportive fascial layer and then the weakened tissue is repaired with stitching.
These stitches will absorb after a period of time, normally varying between four weeks and five months, depending on the type and material used.
The perineal body can also be repaired by putting sutures into the perineal muscles, which work to build up the perineal body.
The skin is closed up using sutures which absorb themselves four to six weeks after the surgery. They therefore do not require medical removal.
In order to help reduce vaginal bleeding and the bruising which can occur after surgery, a pack might be applied into the vagina, along with a catheter in the bladder. These will usually be taken out within 48 hours.
For many patients, a posterior vaginal repair takes place alongside other surgical procedures, which include vaginal hysterectomies, incontinence surgery or anterior vaginal wall repairs.
How do I prepare for surgery?
The doctor will go over your medical history, current health and ask you about any medication you are currently taking. You might be required to undergo blood tests, x-rays or scans to make sure you are able to undergo the surgery. The details of what happens during and after the procedure will be thoroughly discussed with you so that you fully understand the surgery.
You will wake up in hospital and may feel the effects of the anaesthetic wearing off. A drip will be attached to your body and you may also have a catheter going to your bladder and a pack in the vagina to help reduce bruising, swelling and bleeding. These will be removed professionally within 48 hours.
A creamy discharge from the vagina is common for several weeks after the procedure. This occurs as a result of the stitches and will reduce as the stitches begin to be dissolved by the body. The discharge should not, however, smell, so it’s important to inform your doctor right away if you begin to notice a strong odour. Blood, which is brownish in colour and rather thin, may also be present for up to a week afterwards.
For the first few weeks following surgery, you should avoid strenuous exercise, lifting heavy objects, constipation and coughing. You should be repaired fully in three months’ time.
Between two to six weeks off work is normal, but a more accurate estimate can be given by your doctor and will depend upon the type of surgery undertaken and the job you hold. Light activities, for example short walks, and driving can resume after 3-4 weeks.
We strongly advise against having sex for at least six weeks after surgery, and even then only if you feel comfortable to do so. Many women find that sexual intercourse is a lot easier with lots of lubrication, which can be purchased over-the-counter.
Surgery success rates
This surgery is between 80-90% successful in repairing the posterior vaginal wall, though there is a chance that prolapse can re-occur at a later date or might affect another part of the vagina, in which case, you may need to undergo repeat treatment.
Around 50% of the women who have symptoms related to bowel movements will also see an improvement in their particular symptoms.
What are the risks?
Every surgery carries some element of risk and your doctor will go through these with you in detail.
General complications which can arise after any surgical procedure include:
- Anaesthetic issues – these are very rare nowadays.
- Bleeding – less than 1% of women who undergo vaginal surgery will experience serious bleeding which requires blood transfusion.
- Infection – There is a very small chance of developing an infection in the vaginal or pelvic area.
- Bladder infection – Around 6% of women will experience cystitis and this is more prevalent in those who have had a catheter fitted. Cystitis is easily treatable with antibiotics.
The complications which specifically relate to the posterior vaginal wall repair surgery include:
- Constipation – this is common after surgery and can be easily treated with laxatives and a high-fibre diet, as well as drinking lots of water.
- Pain or discomfort during sex – Some women might experience this and it is often unavoidable. On the contrary, many women report an improved sex life after their prolapse repair.
- Rectal damage – this complication is rare.