Vaginal repair surgery (colporrhaphy)

About vaginal repair surgery

The muscles and the ligaments that support your vagina and womb can become overstretched and weakened if you’re obese or after certain events, such as after childbirth or the menopause. This can cause your vagina and womb to drop down. Your bladder and bowel can also bulge into your vagina. The bulge of the womb, bladder or bowel into your vagina is known as a prolapse.

A vaginal prolapse can be repaired with vaginal repair surgery. This operation will help to strengthen the walls of your vagina and ease your symptoms. A gynaecologist, a doctor who specialises in women’s reproductive health, will perform the surgery.

What are the alternatives?

If your prolapse is mild, alternative treatments include:

  • pelvic floor muscle exercises, which will help to strengthen your weakened pelvic floor muscles
  • vaginal pessaries, which will provide mechanical support to your prolapsed organs

These alternative treatments may help control your symptoms. However, if your prolapse is more severe, you may need to have surgery. Your surgeon will discuss your options with you.

See our frequently asked questions for more information.

Preparing for vaginal repair surgery

Your surgeon will explain how to prepare for your vaginal repair surgery.

Vaginal repair surgery usually requires a hospital stay of one to two days, depending on the type of surgery you have and how well you recover. The operation may be done under general anaesthesia, which means you will be asleep during the procedure, or under local anaesthesia, which completely blocks pain from the area and you will stay awake during the operation.

If you’re having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.

At the hospital, your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during vaginal repair surgery?

The operation usually takes about an hour but this will depend on the exact type of operation you have – ask your surgeon how long your operation will take. The exact type of surgery you have will depend on where your prolapse is and how severe it is.

Your surgeon will usually repair your vaginal wall through your vagina. During the operation, your surgeon will use dissolvable stitches to strengthen the tissue that supports your vagina. This may be at the front or the back wall of your vagina or both, depending on the type of prolapse you have. He or she may also remove some of your excess vaginal skin. Your surgeon may also stitch a mesh over the repaired wall. This will help to give extra support to your vaginal wall.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You may have a catheter to drain urine from your bladder into a bag. You may also have a gauze dressing in your vagina to reduce bleeding. Both of these will usually be removed after a day or two.

Your nurse will give you advice about getting out of bed, having a bath or shower, and eating and drinking. You may see a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) who will give you exercises to do that are designed to speed up your recovery.

You may be constipated after the operation but it's important not to strain when you go to the toilet as it will put pressure on your healing wound. Let your nurse know if you think you may be constipated and they will arrange treatment (such as a laxative) for you.

The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure, they should usually disappear in about one to two weeks.

Your nurse will give you some advice about caring for your surgical wounds before you go home. You may be given a date for a follow-up appointment.

You will need to arrange for someone to drive you home. Try and have a friend or relative stay with you for the first 24 hours after your operation if you’re discharged on the day of your surgery.

Recovering from vaginal repair surgery

It usually takes about six weeks to make a full recovery from vaginal repair surgery, but this varies between individuals, so it's important to follow your surgeon's advice. It’s best not to have sex until at least six weeks after your operation. Your surgeon will give you advice about when you can resume your usual activities and return to work at your follow-up appointment.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You may have some blood-stained vaginal discharge after surgery but if this becomes smelly or changes in colour, or if you have pain and feel unwell, contact your doctor for advice as you may have an infection.

What are the risks?

As with every procedure, there are some risks associated with vaginal repair surgery. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of vaginal repair surgery include:

  • pain and discomfort in your abdomen (tummy) and vagina
  • vaginal bleeding

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications of vaginal repair include:

  • infection – you may need to take antibiotics to treat this
  • damage to your womb, vagina or cervix, and/or part of your bladder or bowel – you may need more surgery to repair the damage
  • problems passing urine – this usually improves without further treatment
  • mesh-related complications – your surgeon will discuss these with you before surgery

Vaginal repair surgery doesn't always repair a prolapse completely and some women find that the prolapse comes back. If this happens, you may need more surgery. Vaginal repair surgery may not ease the problems a prolapse can cause, such as bladder and bowel symptoms or resolve sexual problems. It’s important that you discuss what you can realistically expect from the operation with your surgeon prior to getting treatment.

What are pelvic floor muscles and why do I need to strengthen them?

Answer

Pelvic floor muscles span the area between your legs. They support your bladder, uterus and bowel and help them to work properly. You can strengthen the muscles in your pelvic floor by doing exercises, which may help to treat a mild prolapse or prevent a prolapse from developing.

Explanation

Pelvic floor muscles form a sling passing from your coccyx (tip of your spine) at the back, to your pubic bone at the front. Your body keeps the muscles of your pelvic floor tense until you need to pass urine and open your bowels.

The following is a guide of how to do pelvic floor muscle exercises. If you have just had surgery to repair a prolapse, check with your physiotherapist or surgeon before you do these exercises.

  • Get into a comfortable position, either lying on your back or sitting upright in a chair.
  • Imagine trying to stop yourself passing wind and urine. This should feel like a squeeze and lift inside.
  • Squeeze and lift for 10 seconds as strongly as you can. Rest for 10 seconds and repeat 10 times. Follow with 10 fast squeezes.
  • Do this three times every day. Breathe normally as you do the exercises.

You should be able to feel the benefits of these exercises within three to five months.

Are pessaries a better treatment for me than vaginal repair surgery?

Answer

You can use pessaries to treat a prolapse if it's mild, or if there are reasons why you can't have surgery, or would prefer not to have it.

Explanation

Pessaries are soft devices, similar to a diaphragm or cervical cap, which are inserted into your vagina to hold the walls in place. The most commonly used pessary is a ring pessary, which is available in a number of different sizes. It may take more than one go to find the right size for you. Other types of pessary, such as shelf and doughnut pessaries, are available but aren't used as often.

Your nurse or GP will change the pessary for you every three to six months and check to see that your vagina is healthy. Once he or she has inserted the pessary you shouldn't be able to feel it.

You can have sex with a ring pessary in place but sometimes they can cause vaginal dryness. If you have any problems, ask your nurse or GP for advice.

How can I prevent constipation after having vaginal repair surgery?

Answer

It's important to try and prevent constipation after vaginal repair surgery. You can prevent it by drinking enough fluids and eating foods that contain fibre, such as fruit and vegetables.

Explanation

Mild constipation is common after surgery. It's important to try and prevent constipation because straining when you go to the toilet is uncomfortable and will put pressure on your healing wound.

To keep your bowel function regular:

  • eat high-fibre foods such as wholegrain bread, fruit and vegetables
  • keep hydrated by drinking enough fluids
  • be active as soon as you feel able to

If these measures don’t help, ask your GP for advice.