Cystocele and Rectocele Repair

What is a cystocele and rectocele repair?

A cystocele and rectocele repair is an operation that lifts and tightens the tissue around the bladder and rectum so these organs no longer push into the vagina.

When is it used?

Surgery is done to relieve bulging into the vagina that may be caused by a cystocele and rectocele. This problem may cause symptoms such as:

• discomfort
• leaking of urine or bowel movements (incontinence)
• constipation (infrequent bowel movements)
• urinary tract infection
• painful sexual intercourse
• vaginal infection and bleeding if the problem is severe.

Surgery is usually done only after you have tried other treatments such as:

• doing muscle-strengthening exercises, called Kegel exercises
• placing a pessary in the vagina (A pessary is a device that can be put into the vagina to support the vaginal walls. A pessary does not help a rectocele problem, but it can help with a cystocele.)
• placing a diaphragm or tampon in the vagina to support its walls.

Ask your healthcare provider about these other treatment choices.

How do I prepare for a cystocele and rectocele repair?

Plan for your care and recovery after the operation. Find someone to drive you home after the surgery. Allow for time to rest and try to find people to help you with your day-to-day duties.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

Follow any other instructions your provider gives you. You may be asked to take an enema or medicine to clean out your bowel the day before surgery. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You are given a regional or general anesthetic. A regional anesthetic numbs part of your body while you remain awake. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.

Your healthcare provider will make two cuts in the wall of the vagina, exposing the tissue between the vagina and the bladder and the tissue between the vagina and the rectum. Your provider will try to support these organs by bringing tissue from the sides around them. He or she will remove any extra tissue from the vaginal wall that has stretched from aging or pregnancy. If incontinence is a significant symptom, your provider may also perform an elevation or suspension procedure on the bladder. Then the cuts in the vagina will be sewn closed.

Your provider may put a catheter (tube) into your bladder to drain urine. The tube may pass through the urethra (the tube through which urine normally flows) or your provider may insert it through a cut in the abdominal wall and into the bladder. This will help you pass urine while you are recovering and decrease the pressure inside your bladder.

What happens after the procedure?

You may stay in the hospital about 2 to 6 days. The catheter may stay in your bladder 2 to 6 days or until your bladder starts working normally again, which may take 4 to 6 weeks. You may be constipated during this time.

During the first 4 weeks after the operation, you may have some smelly, sometimes bloody drainage from your vagina.

After you leave the hospital, avoid all heavy activity such as lifting for the first 6 to 8 weeks. Then follow your provider's recommendations for gradually increasing your activity.

Ask what other steps you should take and schedule follow-up visits with your healthcare provider.

What are the benefits of this procedure?

The procedure should allow easy, effective, and complete urination and better bowel control. It should help you to be more active. You might be able to resume your normal level of activity without leaking urine. Bulging and pressure sensations in the vagina will be relieved. Intercourse should be more comfortable and enjoyable.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. In older adults, mild to severe confusion can occur. Discuss these risks with your healthcare provider.
• The regional anesthetic may not numb the area quite enough and you may feel some minor discomfort.
• There may be damage to the bladder and rectum. If damage occurs and your provider is aware of it, he or she will try to correct it during the operation.
• You may have infection or bleeding.
• The catheter can become blocked and need to be replaced.
• The ureter, urethra or bladder may be damaged and need more surgery.
• You may keep having leaking of urine or bowel movement.
• The cystocele or rectocele may come back.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• The catheter becomes plugged and you stop passing urine.
• You develop a fever over 100°F (37.8°C).
• You have heavy bleeding from your vagina.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.