Vaginal Repair Surgery

Vaginal Repair (Colporrhaphy)

Vaginal repair surgery, clinically known as Colporrhaphy, is a procedure used to reinforce and strengthen the vaginal walls when they have become weakened or stretched. This is most commonly performed to treat pelvic organ prolapse, such as a Cystocele (bladder bulging into the vagina) or a Rectocele (rectum bulging into the vagina), restoring the pelvic organs to their correct anatomical positions.

When You Should Consider Vaginal Repair

• Physical Bulge: Feeling or seeing a lump at or poking out of the vaginal opening, especially after long periods of standing or straining.

• Pelvic Pressure: A constant "heavy" or dragging sensation in the lower pelvis that may improve when lying down.

• Bladder Dysfunction: Difficulty emptying the bladder completely, a frequent urge to urinate, or recurrent urinary tract infections (UTIs).

• Bowel Issues: Difficulty having a bowel movement or the need to "splint" (pressing on the vaginal wall with a finger) to assist a bowel movement.

• Childbirth Injury: If the perineum (the area between the vagina and anus) was severely torn or stretched during delivery, causing functional or cosmetic concerns.

Types of Repair

• Anterior Repair: Focuses on the front wall of the vagina to support and lift a prolapsed bladder.

• Posterior Repair: Focuses on the back wall of the vagina to support a prolapsed rectum.

• Perineorrhaphy: Often performed alongside a posterior repair to strengthen the perineum and the muscles around the vaginal opening.

• Enterocele Repair: A specialized repair for the top of the vaginal wall if the small intestine is bulging into the vaginal space.

How Is Performed

• Access: This is a "scarless" surgery performed entirely through the vaginal opening. There are no abdominal incisions or external scars.

• Anesthesia: The surgery is typically performed under general or spinal anesthesia and takes about 30 to 60 minutes.

• The Procedure: The surgeon makes a precise incision in the vaginal lining to reach the underlying supportive tissue (fascia).

• Reinforcement: The shifted organ (bladder or rectum) is moved back into its proper place, and the surgeon uses permanent or long-lasting dissolvable stitches to tighten and "pleat" the weakened fascia.

• Trimming: Any excess or overstretched vaginal skin is trimmed away to ensure a firm, supportive wall before the incision is closed with dissolvable sutures.

Pre-Procedure Preparation

• Pelvic Floor Exam: A detailed assessment to determine which compartments of the vagina require reinforcement.

• Urodynamic Studies: To check how well the bladder is functioning and ensure the repair won't cause new urinary leakage.

• Bowel Management: Starting a high-fiber diet or mild stool softeners a few days before surgery to ensure a "soft" first bowel movement post-op.

• Smoking Cessation: Stopping smoking at least 6 weeks prior is vital, as chronic coughing puts immense pressure on the new stitches and can cause the repair to fail.

• Fasting: Following "nothing by mouth" instructions for 8 hours prior to your scheduled anesthesia.

Tests Before Vaginal Repair

• Post-Void Residual (PVR) Scan: A simple ultrasound to measure how much urine stays in the bladder after you try to empty it.

• Pelvic Ultrasound: To rule out other issues like uterine fibroids or ovarian cysts that might be contributing to pelvic pressure.

• Cystoscopy: A quick look inside the bladder to ensure the lining is healthy before the anterior wall is repaired.

• ECG: A routine heart check to confirm you are healthy enough for the duration of the surgery.

Life After Vaginal Repair

• Hospital Stay: Most patients stay in the hospital for one night to ensure they can urinate comfortably and that pain is well-controlled.

• Immediate Symptoms: It is normal to experience mild vaginal bleeding and a "watery" discharge for 2 to 4 weeks as the internal stitches dissolve.

• The "6-Week Rules": To prevent the stitches from tearing and ensure the repair holds for the long term, you must strictly avoid:
  Heavy Lifting: Nothing heavier than 2kg (roughly a bag of sugar).
  Straining: Stool softeners are essential to prevent constipation and abdominal pressure.
  Sexual Activity: No intercourse or use of tampons while the vaginal lining heals.
  High-Impact Exercise: No running, jumping, or heavy core training.

• Pelvic Floor Physiotherapy: Many patients are referred to a specialist therapist after 6 weeks to learn how to properly strengthen the muscles that support the new repair.

Why Specialized Treatment Is Highly Effective

• Restores Quality of Life: Eliminates the physical discomfort and the "bulge" sensation, allowing for a more active and comfortable lifestyle.

• Incision-Free Technology: Performing the surgery through the vagina avoids the risks and recovery time associated with abdominal surgery.

• Functional Restoration: Significantly improves bladder and bowel control by returning the organs to their natural anatomical positions.

• Long-Lasting Support: The use of specialized, high-strength sutures ensures the internal "scaffolding" of the vagina is rebuilt to last.

• Combined Approaches: Surgeons can often address multiple types of prolapse (bladder, rectum, and perineum) in a single, short surgical session.