What Is Colporrhaphy?

Colporrhaphy is a surgery used to repair weaknesses in your vaginal walls, also known as pelvic organ prolapse (POP). A prolapse if commonly referred to as a hernia. Studies show that around 16% of women aged 45 to 55 experience mild pelvic organ prolapse, while only 3% experience prolapse severe enough to warrant surgical repair.

Pelvic organ prolapse occurs when the organs inside your pelvis slip out of place, drop down and start to press against the walls of the vagina. These drooping organs create a bulge in the vagina which can cause pain, discomfort, and urinary and bowel incontinence.

The most common types of surgery correct either a protrusion of the bladder into the vagina (cystocele) or the protrusion of the rectum into the vagina (rectocele). Colporrhaphy can fix these structural issues in your pelvis, which can vastly improve your symptoms and overall quality of life.

What Is Pelvic Organ Prolapse?

Your pelvic organs have tissues such as muscles and ligaments that hold them in place. Certain factors may cause those tissues to weaken, resulting in a prolapse of the organs. Factors that contribute towards pelvic organ prolapse include age, repeated childbirth, hormone deficiency, strenuous physical activity, and prior hysterectomy.

There are different kinds of pelvic organ prolapses, namely:

• A cystocele - the protrusion or prolapse of the bladder into the vagina
• A urethrocele - the prolapse of the urethra into the vagina. As with a cystocele, this is caused by a defect in the pubocervical fascia (fibrous tissue that separates the bladder and vagina)
• A rectocele - the prolapse of the rectum into the vagina. It is caused by a defect in the rectovaginal fascia (fibrous tissue that separates the rectum and vagina)
• An enterocele - the prolapse of the small intestine into the vagina
• Uterine prolapse – the prolapse of the uterus into the vagina

What Are The Symptoms Of Pelvic Organ Prolapse?

The symptoms of pelvic organ prolapse can be very distressing and may include:

• Stress incontinence (uncontrolled leakage of urine with physical activity)
• A vaginal bulge
• Painful sexual intercourse
• Back pain
• Difficult urination or bowel movements
• Urinary and faecal incontinence (difficulty controlling when you pee or poop)

Who Can Have Colporrhaphy?

Pelvic organ prolapse can produce debilitating and embarrassing symptoms which can significantly affect a woman’s quality of life.  Several surgical and non-surgical solutions are available for remedying a prolapse. Your doctor might recommend a colporrhaphy if you meet certain criteria, namely:

Conservative Treatments Have Not Worked

Non-invasive treatments, that aim to strengthen your pelvic floor muscles or hold your organs in place, are the first line of treatment for pelvic organ prolapse. These treatments include pelvic floor exercises (also known as Kegels), devices such as pessaries, and hormone therapy. When none of these treatments have worked, your doctor may recommend surgery.

You Experience Troublesome Symptoms

Colporrhaphy is major surgery which, as with any surgery, involves potential risks. Many women with POP do not experience any disruptive symptoms and it is not necessary for them to have surgery. Only women who experiencing discomfort are usually considered eligible for a colporrhaphy.

You Do Not Want More Children

Colporrhaphy is not recommended for women who still desire to have children. Having a child after surgery may increase the risk of a prolapse reoccurring. It is advised to wait until you have finished having children before considering surgery. 

Different Types Of Colporrhaphy

Colporrhaphy is a minimally invasive procedure that only requires small vaginal incisions. It is far less invasive than more traditional types of pelvic reconstructive surgeries that require a large abdominal cut.

There are two ways of performing a colporrhaphy. Cystoceles and urethroceles, which cause abnormalities to the front of the vaginal wall are repaired by performing an anterior colporrhaphy. A posterior colporrhaphy repairs rectoceles that usually occur in the back of the vaginal wall.

Rectocele Repair (Posterior Colporrhaphy) 

A rectocele occurs when the wall between the rectum and the vagina weakens, causing the rectum to push into the vagina. Rectocele repair removes your bowel hernia from the vagina by strengthening and tightening the muscles in the back of the vaginal wall, which can then support the prolapsed organs.

Cystocele Repair (Anterior Colporrhaphy)

A cytocele, also known as an anterior wall prolapse, develops when weakened muscles in between your bladder and vagina cause your bladder to sag onto your vagina’s front wall. Cystocele repair aims to tighten the muscles in the front wall of the vagina that hold your bladder in place. 

How Is Colporrhaphy Performed?

You will first be given either general anaesthesia or local anaesthesia. Your surgeon will then widen your vagina with a speculum to make it easier to view your vaginal walls. A vertical incision (cut) is then made in your vagina to expose the weakened parts of your muscles and tissues involved in the prolapse (hernia).

During an anterior colporrhaphy, your surgeon will make small incisions along the top wall of your vagina. For a posterior colporrhaphy, the cuts will be made along the back wall of the vagina. The strong parts of your vaginal walls are then sutured (sewed) together. Your surgeon might decide to insert a mesh to strengthen the vaginal wall. When finished, your incisions will be closed with stiches.

Recovering From Colporrhaphy

Depending on the extent of your surgery, you are likely to experience the following after surgery:

• You may be able to go home the same day, or you may need to stay in hospital overnight.
• Your surgeon will probably insert a pack into your vagina to absorb blood. This can normally be removed after 24 hours.
• You might need a catheter if you are not able to pass urine on your own – this can normally be removed within 2 days.
• You may need to use stool softeners or gentle laxatives to help you open your bowels  without placing strain on healing muscle and tissue.
• You may be prescribed vaginal oestrogen if you are post-menopausal which may speed healing and reduce your risk of a urinary tract infection (UTI) after surgery.
• You may have trouble with emptying your bladder for a few days.
• You may have a bloody vaginal discharge for a few days.
• You may have a creamy vaginal discharge for a few weeks which is a sign of your body absorbing the stiches.
• You may experience vaginal pain for up to six weeks.