Colporrhaphy for vaginal prolapse

Vaginal prolapse occurs when the uterus, cervix, the bowel (large or small) or the bladder bulges into the wall of the vagina.

The condition can affect the front, back or top of the vagina and sometimes more than one prolapse can be present at the same time. The three most common types of prolapse are:

• Anterior prolapse (or cystocele) - where the bladder bulges into the front of the vagina
• Vault descent at the top of the vagina, perhaps due to previous surgery to remove the womb (hysterectomy)
• Posterior wall prolapse (rectocele or enterocele) - where the bowel bulges into the back of the vagina

A prolapse is caused by weakness of the tissues that support the organs within the pelvis. There’s usually more than just one cause and your risks of suffering a prolapse are increased by:

• Age - prolapses are more common the older you are
• Childbirth - the more children you have had, and the more difficult and prolonged your labour, the more likely you are to suffer a prolapse
• Menopause - can change hormone levels and weakening tissue
• Being overweight - can create extra pressure in the pelvic area
• Having fibroids (non-cancerous tumours of the womb) or pelvic cysts
• Earlier pelvic surgery - a hysterectomy for example
• Manual work or heavy lifting
• Coughing or sneezing over a long period - due to smoking, a lung condition or an allergy
• Constipation and straining when going to the toilet
• Suffering from certain conditions such as Ehlers-Danlos syndrome, Marfan syndrome or joint hypermobility syndrome

The risks of suffering from a prolapse can be reduced by doing regular pelvic floor exercises, by eating a healthy diet (to avoid constipation and straining on the toilet), by maintaining a healthy weight, by not smoking, reducing caffeine and alcohol intake - as they can irritate the bladder - and by avoiding lifting heavy weights.

Symptoms of a vaginal or pelvic prolapse may include a bulging sensation within the vagina, pain or discomfort during sex or problems passing urine.

Symptoms will vary according to the type of prolapse suffered, and its severity; you may experience more symptoms if it is a severe pelvic prolapse. Many women don’t feel any symptoms at all and may only realise they have a prolapse when it is discovered during an examination for another reason (such as a regular cervical screening).

You may have problems passing urine. These may include a slow stream, a feeling of not being able to fully empty your bladder, needing to urinate more often or perhaps leaking a small amount of urine when you cough, laugh, sneeze or exercise (stress incontinence).

• A sensation of bulging within the vagina
• A feeling of something coming down or out of the vagina
• Pain or discomfort during sex
• Problems passing urine
• Constipation or difficulty emptying the bowel
• Stress incontinence

You should see your GP if you notice a lump in or around your vagina or have any of the symptoms of a prolapse. By discussing your symptoms and carrying out a short internal pelvic examination, they should be able to diagnose your condition and suggest some treatment options.

You may need to be referred to our Consultant Gynaecological Surgeons for further tests.

Vaginal prolapse surgery, or colporrhaphy, is the surgical repair of either the front (anterior) or rear (posterior) vaginal walls, or sometimes both, to treat a vaginal prolapse.

A colporrhaphy returns the prolapsed vagina back to its natural position, repairs the wall tissue and can strengthen the structure of the vagina to help prevent a prolapse reoccurring.

Sacrospinous fixation may also be recommended for a vaginal prolapse.

The operation may be carried out under a general anaesthetic (so you’ll be asleep) or a spinal anaesthetic (so you’ll stay awake but won’t feel anything).

The surgery is carried out through the vagina. The vaginal wall will be cut so the protruding organ can be lifted back into its correct position. Normally sutures will be used to strengthen the wall repair and the cut will be stitched using dissolvable sutures. Occasionally it may be suggested that a synthetic or biological mesh will be used.

You’ll need to stay in hospital for two or three days. Immediately after surgery we’ll help you manage any pain or discomfort with painkillers. We’ll discuss your aftercare and arrange any follow-up appointments with you before you leave hospital.

You may experience vaginal bleeding or discharge for a couple of weeks or so after your operation.

You’ll need to eat a healthy diet and you may need to take laxatives to avoid constipation and straining when you go to the toilet. You won’t be able to drive for about four weeks or lift anything heavy for around eight to twelve weeks. Depending on the type of work you do you may not be able to return to work for four to six weeks.