Your Health - Cystocele and Rectocele Repair

Cystocele and Rectocele Repair

Pronounced: SIS-toh-SEEL or RECK-toh-SEEL

Definition

A cystocele occurs when part of the bladder wall bulges into the vagina. The bulge happens through a defect in the tissue between the bladder and vagina.

Cystocele

A rectocele occurs when part of the wall of the rectum bulges into the vagina. The bulge happens through a defect in the tissue between the rectum and vagina.

Rectocele

These form because of a problem with pelvic support tissues (eg, fascia, ligaments, and muscle).

Reasons for Procedure

These repairs are done to stop symptoms like problems going to the bathroom, urine leakage, or pain during sex. Most often, this type of surgery is not done until other treatments have been tried. Other treatments may include muscle exercises and the insertion of a pessary device (a device put into the vagina to try to push the bladder or rectum back into place). If you have tried these treatments and experienced no relief, your doctor may suggest surgical repair.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have this type of repair, your doctor will review a list of possible complications, which may include:

Adverse reaction to anesthesia
Infection
Bleeding
Accidental damage to vagina, rectum, and bladder
Accidental damage to nearby organs

What to Expect

Prior to Procedure

Talk to your doctor about your current medicines. Certain medicines may need to be stopped before the procedure, such as:
- Aspirin or other anti-inflammatory drugs for up to one week before surgery
- Blood-thinning drugs like clopidogrel (Plavix) or warfarin (Coumadin)

Eat a light meal the evening before the surgery.
Do not have anything to eat or drink after midnight on the night before the procedure.
If you are having a rectocele repair, you may need to have an enema the night before the surgery.

Anesthesia

You will often have your choice of either general or regional anesthesia . With general anesthesia, you will be asleep. Regional anesthesia will numb your lower body, but you will be awake.

Description of the Procedure

A bladder catheter will be inserted in the urethra to decrease pressure on the bladder.

A cut in the skin will be made to expose the involved muscle and tissue. In some cases, the muscles and tissue will be sewn back onto itself. This will make it stronger. In other cases, a mesh-type material will be used to strengthen the tissue. Any tissue that has been weakened by previous surgeries, pregnancies, or age will be removed. Excess vaginal lining will be removed as well.

In some cases, a suspension or elevation procedure may be done to provide extra support to the bladder.

How Long Will It Take?

45 minutes to two or more hours

How Much Will It Hurt?

You will likely experience vaginal discomfort for 1-2 weeks following the surgery. You will be given medicine to help relieve this.

Average Hospital Stay

The usual length of stay is 1-2 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital

A medicated vaginal packing is usually left in the vagina overnight.
If you had a rectocele repair, the bladder catheter will be removed as soon as you are able to use the restroom on your own. If you had a cystocele repair, the bladder catheter often needs to stay in longer (sometimes 2-6 days). This will allow the bladder time to begin working normally again.
You may notice a smelly, even bloody, discharge from the vagina for 1-2 weeks.

At Home

When you return home, do the following to help ensure a smooth recovery:

Avoid lifting anything that weighs more than 10 pounds for about six weeks.
Avoid sexual intercourse for about six weeks.
Avoid inserting anything into the vagina (eg, tampons) for about six weeks.
Have someone to help you at home for a few days following the surgery.
Drink plenty of fluids and eat a healthy, high fiber diet to keep stools soft.
Be sure to follow your doctor’s instructions .

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills
Excessive bleeding, or any discharge from the incision site
Unusually heavy vaginal bleeding, or foul-smelling discharge from the vagina
Nausea or vomiting
Pain that you cannot control with the medicines you have been given
Inability to pass urine into catheter
Pain, burning, urgency, or frequency of urination, or persistent bleeding in the urine
Cough, shortness of breath, or chest pain

In case of an emergency, CALL 911 .

RESOURCES:

American Congress of Obstetricians and Gynecologists
http://acog.org/

National Kidney and Urologic Diseases Information Clearinghouse
http://kidney.niddk.nih.gov/

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org/

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/

References:

ACOG Education Pamphlet. American College of Obstetricians and Gynecologists. Available at: http://www.acog.org/publications/patient_education/bp012.cfm . Accessed July 21, 2008.

Agarwala N, Hasiak N, Shade M. Graft interposition colpocleisis, perineorrhaphy, and tension-free sling for pelvic organ prolapse and stress urinary incontinence in elderly patients. J Minim Invasive Gynecol . 2007;14:740-745.

DeLancey JO. Functional anatomy of the female pelvis. Female Urology . Philadelphia, PA: JB Lippincott;1994:3-16.

Kobashi KC, Leach GE. Pelvic prolapse. Journal of Urology . 2000;164(6):1879-90.

Richardson AC. The anatomic defects in rectocele and enterocele. Journal of Pelvic Surgery . 1995;1:214-221.

Last reviewed July 2010 by Adrienne Carmack, MD

Last updated Updated: 7/9/2010

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.