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 against the vagina.

Surgery is done to relieve bulging into the vagina that may be caused by a cystocele and rectocele. Surgery is usually used 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.)

Ask your health care provider about these other treatment choices.

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 health care 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.

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 health care 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 around them. He or she will remove any 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 place a catheter (a tube for urine passage) in your bladder and lead it out through a cut made in your lower abdominal wall. This will help you pass urine during recovery and it decreases the pressure inside the bladder.

You may stay in the hospital about 2 to 6 days. The catheter may remain in your bladder 2 to 6 days or until your bladder starts working normally again. 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 health care provider.

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.

• There are some risks when you have general anesthesia. In older adults, mild to severe confusion can occur. Discuss these risks with your health care 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.

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

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.