Cystocele and Rectocele Repair

What is a cystocele and rectocele repair?

Cystocele and rectocele repair is surgery that is done to lift and tighten the tissue around the bladder and rectum so that these organs no longer push into the vagina.

A cystocele happens when the bladder pushes against weakened tissue in the vagina and drops down into the vagina. A rectocele happens when the rectum presses into the vagina.

When is it used?

Surgery may be done to relieve symptoms caused by bulging of the bladder and rectum into the vagina. Some of the symptoms a cystocele and rectocele may cause are discomfort, leaking of urine or bowel movements, bladder infections, constipation, and pain during sex.

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

  • doing muscle-strengthening exercises, called Kegel exercises
  • putting a pessary (a silicone or plastic ring or disc) in the vagina to push the bladder up and back in place

Ask your provider about your choices for treatment.

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 these reasons, 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.

Your provider may ask you to take an enema or medicine to clean out your bowel the day before surgery.

Follow any other instructions your provider gives you. 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 will be 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 keeps you from feeling pain. Sometimes a regional anesthetic and a sedative are given instead of a general anesthetic. This has fewer risks than general anesthesia.

Your healthcare provider will make incisions (cuts) in the wall of the vagina, exposing the tissue between the vagina and the bladder and between the vagina and the rectum. Your provider will try to support these organs by bringing tissue around them. Stretched or extra tissue around the bladder may be removed.

If leaking urine (incontinence) has been a problem, your provider may use a polyester mesh to cradle and lift the urethra and bladder. This is called an elevation or suspension procedure.

The cuts in the vagina will be sewn closed.

Your provider may put a catheter (tube) into your bladder to drain urine. The catheter may be put into the urethra (the tube that carries urine out of the body) or your provider may insert it into the bladder through a cut in the wall of your lower belly. This will help you pass urine while you are recovering. It will also decrease pressure inside your bladder.

What happens after the procedure?

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

During the first 4 weeks after the operation, you may have some drainage from your vagina. It may be bloody or pinkish.

After you leave the hospital, follow your provider’s recommendations for slowly increasing your activity. Avoid all heavy activity such as lifting for the first 6 to 8 weeks.

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

What are the benefits of this procedure?

The procedure should allow you to urinate normally again and you should have better bowel control. You may be able to go back to your usual activities without leaking urine. Bulging and pressure sensations in the vagina will be relieved. Sex 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, rectum, ureter, or urethra. If damage occurs and your provider is aware of it, he or she will try to repair it during the operation.
  • You may have infection or bleeding.
  • The catheter may get blocked and need to be replaced.
  • You may keep leaking urine or bowel movements.
  • You may have urination problems or urgency.
  • The cystocele or rectocele may come back.

Ask your provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

  • The catheter gets plugged and you stop passing urine.
  • You have a fever over 100.5°F (38°C).
  • You have heavy bleeding from your vagina.
  • You become dizzy and faint.
  • You have nausea and vomiting.
  • You get short of breath.
  • You have severe pain in the area of the surgery, your chest, or legs.

Call during office hours if:

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

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Published by RelayHealth.
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