Colporrhaphy



Definition

Colporrhaphy is the surgical repair of a defect in the vaginal wall, including a cystocele (when the bladder protrudes into the vagina) and a rectocele (when the rectum protrudes into the vagina).

In this anterior colporrhaphy, a speculum is used to hold open the vagina, and the cystocele is visualized (A). The wall of the vagina is cut open to reveal an opening in the supporting structures, or fascia (B). The defect is closed (C), and the vaginal skin is repaired (D). (Illustration by GGS Inc.)
In this anterior colporrhaphy, a speculum is used to hold open the vagina, and the cystocele is visualized (A). The wall of the vagina is cut open to reveal an opening in the supporting structures, or fascia (B). The defect is closed (C), and the vaginal skin is repaired (D). (
Illustration by GGS Inc.
)

Purpose

A prolapse occurs when an organ falls or sinks out of its normal anatomical place. The pelvic organs normally have tissue (muscle, ligaments, etc.) holding them in place. Certain factors, however, may cause those tissues to weaken, leading to prolapse of the organs. A cystocele is defined as the protrusion or prolapse of the bladder into the vagina; a urethrocele is the prolapse of the urethra into the vagina. These are caused by a defect in the pubocervical fascia (fibrous tissue that separates the bladder and vagina). A rectocele occurs when the rectum prolapses into the vagina, caused by a defect in the rectovaginal fascia (fibrous tissue that separates the rectum and vagina). When a part of the small intestine prolapses into the vagina, it is called an enterocele. Uterine prolapse occurs when the uterus protrudes downward into the vagina.

Factors that are linked to pelvic organ prolapse include age, repeated childbirth, hormone deficiency, ongoing physical activity, and prior hysterectomy . Symptoms of pelvic organ prolapse include stress incontinence (inadvertent leakage of urine with physical activity), a vaginal bulge, painful sexual intercourse, back pain, and difficult urination or bowel movements.


Demographics

Approximately 50% of women report occasional urinary incontinence, with 10% reporting regular incontinence. This percentage increases with age; daily incontinence is experienced by 20% of women over the age of 75. According to a recent study, approximately 16% of women ages 45 to 55 experience mild pelvic organ prolapse, while only 3% experience prolapse severe enough to warrant surgical repair.


Description

Colporrhaphy may be performed on the anterior (front) and/or posterior (back) walls of the vagina. An anterior colporrhaphy treats a cystocele or urethrocele, while a posterior colporrhaphy treats a rectocele. Surgery is generally not performed unless the symptoms of the prolapse have begun to interfere with daily life.

The patient is first given general, regional, or local anesthesia. A speculum is inserted into the vagina to hold it open during the procedure. An incision is made into the vaginal skin and the defect in the underlying fascia is identified. The vaginal skin is separated from the fascia and the defect is folded over and sutured (stitched). Any excess vaginal skin is removed and the incision is closed with stitches.

Diagnosis/Preparation

Physical examination is most often used to diagnose prolapse of the pelvic organs. A speculum is inserted into the vagina, and the patient is asked to strain or sit in an upright position. The physician then inspects the anterior, posterior, upper (apex), and side (lateral) walls of the vagina for prolapse or bulging. In some cases, a physical examination cannot sufficiently diagnose pelvic prolapse. For example, cystogram may be used to determine the extent of a cystocele; the bladder is filled by urinary catheter with contrast medium and then x-rayed.

The patient will be asked to refrain from eating or drinking after midnight on the day of the procedure. The physician may request that an enema be administered the night before the procedure if posterior colporrhaphy will be performed.


Aftercare

A Foley catheter may remain for one to two days after surgery. The patient will be given a liquid diet until normal bowel function returns. The patient will be instructed to avoid activities for several weeks that will cause strain on the surgical site, including lifting, coughing, long periods of standing, sneezing, straining with bowel movements, and sexual intercourse.


Risks

Risks of colporrhaphy include potential complications associated with anesthesia, infection, bleeding, injury to other pelvic structures, dyspareunia (painful intercourse), recurrent prolapse, and failure to correct the defect. A fistula is a rare complication of colporrhaphy in which an opening develops between the vagina and bladder or the vagina and rectum.

Normal results

A woman will usually be able to resume normal activities, including sexual intercourse, about four weeks after the procedure. After successful colporrhaphy, the symptoms associated with cystocele or rectocele will recede, although a separate procedure may be needed to treat stress incontinence. Anterior colporrhaphy is approximately 66% successful at restoring urinary continence.


Morbidity and mortality rates

There is approximately a 1% risk of serious complications associated with colporrhaphy; the procedure is generally viewed to be safe with a very low rate of overall complications.


Alternatives

Surgery is generally reserved for more severe cases of pelvic organ prolapse. Milder cases may be treated by a number of medical interventions. The physician may recommend that the patient do Kegel exercises, a series of contractions and relaxations of the muscles in the perineal area. These exercises are thought to strengthen the pelvic floor and may help prevent urinary incontinence. One study showed an decrease of 62% in the amount of urine leakage among women ages 35 to 75 who performed Kegel exercises regularly for 16 weeks.

A pessary, a device that is inserted into the vagina to help support the pelvic organs, may be recommended. Pessaries come in different shapes and sizes and must be fitted to the patient by a physician. Hormone replacement therapy may also be prescribed if the woman has gone through menopause; hormones may improve the quality of the supporting tissues in the pelvis.


Resources

periodicals

Cespedes, R. Duane, Cindy A. Cross, and Edward J. McGuire. "Pelvic Prolapse: Diagnosing and Treating Cystoceles, Rectoceles, and Enteroceles." Medscape Women's Health eJournal 3, no. 4 (1998).

Viera, Anthony, and Margaret Larkins-Pettigrew. "Practice Use of the Pessary." American Family Physician 61 (May 1, 2000): 2719–26.


organizations

American Academy of Family Physicians. 8880 Ward Parkway, Kansas City, MO 64114. (816) 333-9700. http://www.aafp.org .

American Board of Obstetrics and Gynecology. 2915 Vine Street, Dallas, TX 75204. (214) 871-1619. http://www.abog.org .

American Urological Association. 1120 North Charles Street, Baltimore, MD 21201. (410) 727-1100. http://www.auanet.org .


other

"Cystocele (Fallen Bladder)." National Kidney and Urologic Diseases Information Clearinghouse, March 2002 [cited March 20, 2003]. http://www.niddk.nih.gov/health/urolog/summary/cystocel .

Jelovsek, Frederick R. "Cystocoele, Rectocoele, and Pelvic Support Surgery." Society of Gynecologic Surgeons, 2001 [cited March 20, 2003]. http://www.sgsonline.org/ed pro002.html .

Miklos, John R., and Robert D. Moore. "Prolapse Treatment." Atlanta Center for Laparoscopic Urogynecology, 2002 [cited March 20, 2003]. http://www.urogynecologychannel.com/pro_treat.shtml .

Stendardo, Stef. "Urinary Incontinence: Assessment and Management in Family Practice." American Academy of Family Physicians, 2002 [cited March 20, 2003]. http://www.aafp.org/PreBuilt/videocme/urinary_mono.pdf .

"Surgical Treatment of Genuine Stress Incontinence." Royal College of Obstetricians and Gynaecologists, August 2002 [cited March 20, 2003]. http://www.rcog.org.uk/resources/worddocs/incontinencedraft.doc .


Stephanie Dionne Sherk

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Colporrhaphy is usually performed in a hospital operating room by a gynecologist or urologist. A gynecologist is a medical doctor who specializes in the areas of women's general and reproductive health, pregnancy, and labor and childbirth. A urologist is a medical doctor who specializes in the diagnosis and treatment of diseases of the urinary tract and genital organs.

QUESTIONS TO ASK THE DOCTOR


User Contributions:

1
Kathy
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Jun 30, 2007 @ 10:10 am
If a woman is 60 and postmenopausal is better to remove the ovaries during a vaginal hysterctomy?
2
Marlene Lambright
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Aug 6, 2007 @ 1:13 pm
I underwent my very first colonoscopy on 03/31/2006. During the procedure, I woke out of sedation screaming, and then I was put back down under.The following week, my right leg swelled fist size into a bloodclot. It was too painful to sit without a pillow as well. I had to use a cain for months, and as of today I use a walker. I have been telling doctors that I was fine before the colonoscopy 03/31/06. No one believes me. I went all the way to New Jersey to Dr. Patrick Foye MD. He does not believe me also. I had a rectal EMG and EMG for both lower legs.Results: Irreversible nerve damage in my rectum. I also have been diagnosed with rectocele recently. I have been getting electric shock treatments through the rectum for 3 months. Now I get to have a machine at home to treat myself permanently.Two surgeons told me that these injuries are from chidbirth 26 years ago. Every doctor I spoke with says that colonoscopies do not and hever has been heard of injurying anyone. I am handicapped for life now..My family docotor wants me to see a psychiatrist..I was walking and in good physical shape before 03/31/06..do you know any other human being that has been injured by a colonoscopy? Thanks, Marlene Lambright 614-624-6022
3
Mary
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May 9, 2008 @ 10:10 am
I too, in October of 2007 at age 53, had undergone a routine colonoscopy (my 1st and only) shortly AFTER which, I discovered Rectocele - and it scared the heck out of me. I have been having problems with urination, constipation, and back and leg pain ever since. I believe that during the colonoscopy there was a "surge" of air into the rectum (which was to be bathed with air to facilitate visibility), that caused the stretching and/or weakening which in effect, caused all these problems. These Dr's will not admit to this procedure causing these problems, but I know this is when all my problems began. I believe that the medical profession has an obligation to convey a warning to women and to list the colonoscopy as a possible cause for pelvic prolapse, and should be held accountable for this negligence when they lie in the name of self-interest- taking a course of action to cover up the truth. Instead they should be telling us that this is what happened during the procedure, and the possibility of pelvic prolapse, and options for treatment. Needless to say, I am very disgusted with the medical profession and their cover-ups.
4
caroline
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Oct 14, 2008 @ 6:06 am
I have just had a bladder and anterior repair,I can get no info that tells you exactly what you can and cannot do the phsio in the hospital said you cannot even lift the kettle,the consultant said just no heavy lifting!!I need exact detail!! can u go on car journey's,how far should you walk and how soon after op?what exactly should you do and not do it is a minefield I do not want to be lazy but I want to be ralistic help!!!!
5
alexander
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Feb 5, 2009 @ 9:09 am
i am need information, because very very important or my health in the world
6
alexander
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Feb 5, 2009 @ 9:09 am
i am architect, but very needed information about medical clinic for my life
7
alexander
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Feb 5, 2009 @ 9:09 am
A gynecologist is a medical doctor who specializes in the areas of women's general and reproductive health, pregnancy, and labor and childbirth. A urologist is a medical doctor who specializes in the diagnosis and treatment of diseases of the urinary tract and genital organs.
8
jo jo
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Feb 25, 2009 @ 12:12 pm
Hi had the interior exterior colporrhaphy + tvt and i must say everything is great , would recomend to all.
9
rachel gonzalez
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Jul 10, 2009 @ 3:15 pm
I recently had surgery for a prolaped hysterectomy and colporrhaphy rectum repair. I was in the best physical condition since high school, I'll be 50 in 8/10/59. The day after surgery I was in so much pain I wanted to die. Went home after 3 days in hospital & continued to feel worse, long story short-have developed an anal fissure from hell. Went to see my OBGYN after a week and she wouldn't even touch me instead referred me to an ass specialist. It;s been for weeks since my surgery,I can bearly do chores at home, can't sit, stand, lye down for to long cause I'm in so much pain, so my questions is "is it possible that my fissure occurred during the surgery?" Any comments, please let me know.
10
connie
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Jan 2, 2012 @ 4:16 pm
I need some help i had a colporraphy done 3 months ago and I'having pain after I empty my blader I feel some presure on my lower abdomen (on my pelvic area).We tried to have sex about 2 weeks ago and we couldnt .Have any want experience some of this problems.I have a dr appt in two days will see what he have to say about my situation.I'm no happy at all I think it was a waste of time (5weeks) out of work plus deductible,out of pocket ciins and copay
11
jacquie robinson
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Jan 8, 2013 @ 5:05 am
I HAD A COLPORRAPHY DONE ON THE 27TH OF DEC 36 HOUR LATER KNOWING MY OWN BODY I KNEW SOME THING WAS WRONG. TOLD A DOCTOR SHE TOOK A SWAB . TELLING ME IT WOULD BE 2 DAY TO GROW A CULTURE ,I WAS THEN DISCHARGED ON NO MEDICATION THE RESULTS WERE THAT I HAD AN INFECTION BUT THIS INFORMATION WAS NOT SENT TO MY GP AFTER A WEEK OF HELL I CALLED THE EMERGENCY DOCTOR OUTLAST SUNDAY TO FIND OUT I HAVE A MASSIVE W ATER AND PELVIS INFECTION CAN ANYONE TELL ME IF THIS IS THE NORMAL THING THAT HAPPENS
12
Darla
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Sep 22, 2013 @ 8:08 am
I have been reading about colporraphy because I have rectocele and cystole as well as pundental neuralgia. I see that a few other people had trouble after colonoscopy and wonder if that's what caused my pundental nerve damage.
13
Saeed
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Mar 8, 2014 @ 11:11 am
What is treatment of urine retention complication of ant colporrhphy
14
Josephine kizidio
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Apr 23, 2014 @ 1:13 pm
I had colporrhaphy a year ago. I get lower abdominal pain every month like cramps and sometimes I feel pain when bladder is full. I have checked by several doctors but they tell me I am ok. I have ultrasound to check if there is anything wrong but nothing was found. I have also had my uterus removed. Please advice
15
mary w
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Aug 23, 2014 @ 8:08 am
I had a colporrhaphy last oct. and over the last 3/4 mos ive had bladder problems, feels like ive got to urinate and when I go I have to press on lower stomach to get me going them sometimes I pee good and have pain and a feeling all inside and some times I still feel like ive got to and cant. Is this normal?? got appointment in sept to see dr. the repair was vaginal amd rectum both> I think heused mess also/ could that be the problem??
16
Lani
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Sep 27, 2014 @ 2:02 am
I was having problems urinating and bowel movements, & vaginal prolapse, twenty years before I had a hysterectomy. Test stated I had a tumor and unsure if on bladder or urethra. OB/GYN Dr. did a colporrhaphy and I was in so much pain I was in tears after coming home with a Foley Catheter. Returned to surgeon who told me everything was fine. I spent about another three days hysterically in pain until I ended up in emergency room. Appears the foley catheter was not attached to my leg when they released me and nobody noticed it was literally yanking my inside out. After a month on the catheter went back to surgeon who removed catheter and sent me on my way. I got home unable to urinate. Back to the emergency room and a catheter was put back in until a Urology specialist could see me. NOBODY COULD GET ME IN TO SEE A UROLOGIST. I had a raging infection. My primary tried to get me an appointment and so did the OB/GYN (or so she said) tried for 30 more days I was attached to a catheter. I still have the same problems I had when I started, except more abdominal pain. THE KICKER IS THE PATHOLOGY REPORT STATED THIS SO CALLED TUMOR WAS A UTERINE FIBROID. I DON'T HAVE A UTERUS. I suffered so badly, I never went back to doctor, my urine smells like death but I am so traumatized by my experience I wouldn't recommend this to anyone.
17
Dalia
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Nov 23, 2014 @ 6:18 pm
I had tension free taping interior and colporrhaphy done 4 weeks ago on 10/24/2014 I am still spotting with a bit of cramping is that suppose to be normal, it has been 4 weeks since the procedure. Can anyone please tell me if they have had this done and outcome. Thanks
18
Diane Hall
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Apr 7, 2015 @ 6:18 pm
Isn't there any GOOD new out there ? I am scheduled to have a posterior colporrhaphy & midurethal sling done next month, but after reading all of these comments I am a bit concerned. I want to be able to walk and ride my bike without so much discomfort - as it is now, the pressure is so great and my low back starts hurting after just a short while. Here I was HOPING this surgery would help me get more back to normal ? Does anyone have some positive feedback for me ?
19
mary
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Jun 2, 2015 @ 1:01 am
mary I have an appointment next month for sling siruge but any one know about it please help me please
20
Alison
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Nov 27, 2015 @ 6:06 am
I had anterior repair surgery 9 days ago for prolapsed bladder. My post op advise was no lifting and a little exercise everyday. I have tried walking, gradually increasing distance, but each time am still experiencing pain-dragging pain at the wound site and lower stomach. I am worried the bladder is still prolapsed!
21
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Dec 27, 2015 @ 6:18 pm
16 years ago I had a hysterectomy w/o removal of ovaries and posterior colporrhaphy. I was very naive and didnt ask many questions. I was 40 years old, I now need another surgery. I have a hard time having a bowel movement and pee leaks out of me all day long especially right after I pee. I have pain in my groin, buttocks, lower back, legs, arms and neck. my hair is falling out and it hurts when I have sex with my husband. I feel worse off than someone in there 80s. I tried to talk to my new doctor about it and he acts like I'm crazy. I know i cant live like this so im going to have to take my health into my own hands. I requested my medical report from my surgery in 2000 its now on micro film in a storage some where.
22
Carol
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Mar 2, 2016 @ 7:19 pm
Need a colonoscopy . It's been 3years. I get cancer polyps . I just had my bladder fall and was told my vigina is colapsing . They want to put a device in me to hold up the vigina and the bladder in place. Can I still do my colonoscopy like this. Worried about the pre-clean out.
23
joy mary
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Apr 13, 2016 @ 8:08 am
can cystocele occur in women who have undergone hysterectomy?
24
Marcia
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Sep 25, 2016 @ 10:10 am
I had a posterior colporrhaphy done for rectocele on September 12. I stayed overnight in the hospital. I would caution those whose rectocele is not that big, to perhaps consider using a pessary instead, unless they are at the point like I was, where it was impossible to have anything resembling a "normal" bowel movement. A pessary doesn't fix anything, but it does keep you from having to 'splint' (use fingers or thumb via vagina, to force feces out). The recovery time from rectocele or any other sort of "wet" surgical procedure involving the mucous tissues and skin, is NOT short. I took one week off after surgery, but have still been having issues. First I got a bacterial infection (you'll know if you get one by the horrible smell and yellow discharge), and to this moment, every time I move my bowels I start bleeding again. The line of stitches begins just above my anus - like an episiotomy - and extends in an unbroken and lumpy line all the way up the interior vaginal wall to about 2 centimeters short of the vaginal cuff (I had a hysterectomy in 2012). These sorts of surgical incisions are not fast-healing. Be sure you are prepared for that; if your job entails lots of standing, squatting and walking, you may wish to consider an alternative like the aforementioned pessary device. Anything that stretches the incision, is going to make it take longer to heal. I'm already to the point where my patience is close to an end with the healing, though I am happy I had it done. I have been able to take near-normal bowel movements. Other things to be aware of: you will get a LOT of post-surgical swelling; both interior and exterior. It will feel like a small football was stuffed in there. The swelling slowly fades. Sitting is very uncomfortable unless you have a donut pillow. Bacterial infections are very common during the first week post-procedure; if it starts to stink horribly, see your gynocologist right away, for a round of Clindamycin. Eat TONS of fiber, and chew flavored fiber tablets 3-4x a day. Trust me, being constipated after surgery is a horror you do not want, plus it can rip open the stitches. I personally prepared by going on a clear liquid diet 3 days prior to surgery, and drastically limiting any solid food after so I would not need to defecate for a while. It helped tremendously. Even with pain killers, I had zero constipation when I finally did have a bowel movement 5 days post-procedure. Good luck, and read as much as you can online about everything so you won't have any surprises. Yes, even with the complications I've had, I would do it again just to be able to have a normal BM.
25
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Nov 18, 2016 @ 4:16 pm
I had a total hesterectomy bladder sling in 2005 and had all of the problems that are listed I finally had surgery on November 15 2016 to correct the repair of anterior /posterior colorophany except that in my medical records for my hesterectomy and bladder sling to correct pop and Sui in association with my hesterectomy has no mention of the urologist surgeon that done the bladder sling and the obgyn surgeon that performed my hesterectomy only mentions removing my uterus and one overy I recently found out that I have no female parts including my cervix and fallopian tubes even at that I'm told that without the bar code of the mesh that was implanted I have no case how is that so to be done so wrong and nobody is the wiser I just want the truth about what and why for my own personal satisfaction it's not about being compensated it's about just knowing the truth about why all these years I was lead to believe that I still had my cervix my fallopian tubes my vaginal lymph nodes and one overy I never thought twice about why I was never put on hormone therapy and the bladder sling was the whole reason for my treatment of POP and SUI I mean because other than that I've got no history of cervical cancer or uterine cancer makes absolutely no sense to me about why the urologist surgeon is not even mentioned and why the obgyn surgeon lied about removing all of my female parts only for me to find out about it 10 12 years later no wonder why I couldn't get any help for my medical issues I had an ongoing bacteria infection in my vaginal I couldn't have sex with my husband because of the pain and every time I'd try and get help whether it be in the er or my doctors office I got told that I had jock itch or that I had candida vaginitis and that my problematic symptoms were not addressed I ended up in a divorce my medical career being put on hold no car unable to work and living with my parents all because my medical history is out of balance. Even so god bless America because I have 2,600 clock classroom hours in learning the anatomy and physiology and medical terminology and pharmacology and in medical coding and billing and being in good standing with my primary physician for 15 years is the only thing that's gotten me through all of this therefore I truly have been blessed without not one reason for having said so yet should I say yet because everything I've gone through was all so unnecessary without a shadow of a dought and I have to believe that this will be made right for me I hope

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