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 wall between the bladder and vagina.

Cystocele

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

Rectocele

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These form because of a problem with the fascia, ligaments, and muscles of the pelvis.

Reasons for Procedure    TOP

Cystocele and rectocele can cause problems going to the bathroom such as frequent urination, urine leakage, and difficulty urinating. Pain during sex may also occur. This surgery is done to help relieve these symptoms.

Most often, this type of surgery is not done until all other treatments have been tried. Other treatments may include muscle exercises and the insertion of a supportive device called a pessary. If you have tried these treatments and have had no relief, your doctor may suggest surgical repair.

Possible Complications    TOP

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:

  • Reaction to anesthesia
  • Infection
  • Bleeding
  • Accidental damage to vagina, rectum, and bladder
  • Accidental damage to nearby organs

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity

Prior pelvic surgery may increase the risk of complications.

What to Expect    TOP

Prior to Procedure

  • Talk to your doctor about your current medications. Certain medications may need to be stopped before the procedure, such as:
    • Anti-inflammatory medications
    • Blood thinners
    • Anti-platelet medications
  • 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 have 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    TOP

You may be given an antibiotic just before surgery. A tube called a catheter will be inserted in the urethra. This will allow urine to drain and decrease pressure on the bladder.

A cut will be made in the skin 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. These are special sutures that provide extra support to the bladder.

How Long Will It Take?    TOP

45 minutes to two or more hours

How Much Will It Hurt?    TOP

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

Average Hospital Stay    TOP

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

Post-procedure Care    TOP

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 more time to begin to work normally.
  • You may notice a smelly, even bloody, discharge from the vagina for 1-2 weeks.

During your stay, the hospital staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions
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, including 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.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Be sure to follow your doctor’s instructions.

Call Your Doctor    TOP

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

  • 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 medications you have been given
  • Inability to pass urine into the catheter
  • Pain, burning, urgency or frequency of urination, or persistent blood in the urine
  • Cough, shortness of breath, or chest pain

In case of an emergency, call for medical help right away.

RESOURCES:

American Congress of Obstetricians and Gynecologists
http://acog.org
National Kidney and Urologic Diseases Information Clearinghouse
http://kidney.niddk.nih.gov/index.htm

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org
The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org

References:

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.
Bladder prolapse (cystocele/fallen bladder). American Association of Urology Foundation website. Available at:
...(Click grey area to select URL)
Updated January 2011. Accessed December 2, 2013.
Kobashi KC, Leach GE. Pelvic prolapse. Journal of Urology. 2000;164(6):1879-90.
Pelvic organ prolapse. EBSCO DynaMed website. Available at:
...(Click grey area to select URL)
Updated October 30, 2013. Accessed December 2, 2013.
Vaginal prolapse surgery. The Royal Women's Hospital website. Available at:
...(Click grey area to select URL)
. Updated January 2008. Accessed December 2, 2013.
6/2/2011 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last reviewed December 2013 by Adrienne Carmack, MD
Last Updated: 1/27/2014