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& x003E; .


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


  • Why is colphorrhaphy recommended in my case?
  • What non-surgical options are available to treat pelvic organ prolapse?
  • How long after surgery may I resume normal activity?

User Contributions:

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?
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
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.
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!!!!
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
alexander
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Feb 5, 2009 @ 9:09 am
i am architect, but very needed information about medical clinic for my life
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.
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.
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.
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
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
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.
Saeed
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Mar 8, 2014 @ 11:11 am
What is treatment of urine retention complication of ant colporrhphy
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

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