Colpocleisis

1. What is a colpocleisis?
2. What will happen to me before the operation?
3. What will happen to me after the operation?
4. What are the chances of success?
5. Are there any complications?
6. When can I return to my usual routine?

Prolapse of the vagina or uterus is a common condition with up to
11% of women requiring surgery during their lifetime. Prolapse
often occurs as a result of damage to the support structures of the
uterus and vagina.

Symptoms related to prolapse include a bulge or sensation of
fullness in the vagina, or an external bulge that extends outside
of the vagina. It may cause a heavy or dragging sensation in the
vagina or lower back and difficulties with passing urine or stool.

 

Front view of procidentia

What is a colpocleisis?

A colpocleisis (or vaginal closure) is an operation which treats
the symptoms of the prolapse by sewing the front and back walls
of the vagina together. This prevents the vaginal walls from
bulging either into or outside of the vagina and supports the
uterus if it is present. Colpocleisis is only suitable for women
who are not sexually active (and not intending to be at any point
in the future), since the vagina will be closed off, not allowing
vaginal intercourse.
Colpocleisis can be carried out more quickly than other vaginal
reconstructive procedures for prolapse, and so it is particularly
suitable for women with medical problems which may make
them less suitable for longer and more complex operations. It
is associated with high success rates (90-95%), and so may also
be an option for non-sexually active women who have recurrent
prolapse following previous surgeries. It can be carried out in
women either with or without a uterus.

What will happen to me before the operation?
You will be asked about your general health and medication that
you are taking. Any necessary investigations (for example, blood
tests, ECG, chest x-ray) will be organized. You will also receive
information about your admission, hospital stay, operation, preand
post-operative care.

What will happen to me after the operation?
When you wake up from the anesthetic you will have a drip (IV)
to give you fluids and will have a catheter in your bladder. The
catheter is generally removed 24 to 48 hours after the operation.
You will be able to pass urine normally following a colpocleisis
as the opening to the bladder is above the vaginal opening and
thus is not affected by the procedure.
It is normal to get a creamy white or yellow discharge for 4 to
6 weeks after surgery. This is due to the presence of stitches in
the vagina; as the stitches absorb, the discharge will gradually
reduce. If the discharge has a bad smell, contact your doctor. You
may get some blood-stained discharge immediately after surgery
or starting about a week after surgery. This blood is usually quite
minimal and old, brownish looking and is the result of the body
breaking down blood trapped under the skin.

What are the chances of success?
Quoted success rates for colpocleisis are between 90% and 95%.

Are there any complications?
With any operation there is always a risk of complications. The
following general complications can happen after any surgery:
• Anesthetic problems. With modern anesthetics and
monitoring equipment, complications due to anesthesia
are very rare. Surgery can be preformed using a spinal or
general anesthetic. Your anesthetist will discuss what will
be most suitable for you.
• Bleeding. Serious bleeding requiring blood transfusion is
unusual following vaginal surgery.
• Post-operative infection. Although antibiotics are often
given just before surgery and all attempts are made to
keep surgery sterile, there is a small chance of developing
an infection in the vagina or pelvis. Symptoms include an
unpleasant smelling vaginal discharge, fever and pelvic pain
or abdominal discomfort. If you develop a fever or foul
smelling discharge, contact your doctor.
• Bladder infections (cystitis). Cystitis occurs in about 6%
of women after surgery and is more common if a catheterhas been used. Symptoms include burning or stinging when
passing urine, urinary frequency and sometimes blood in
the urine. Cystitis is usually easily treated by a course of
antibiotics.
• Clots in the blood vessels of the legs/lungs. Clots are more
common in patients undergoing pelvic surgery. You will be
given compression stockings to reduce the risk of this, and
possibly also a course of injections.
Specific complications related to colpocleisis:
• Hematoma. Refers to a collection of blood that can
form under the vaginal tissues due to bleeding from the
surfaces that have been sewn together. This can cause
pain and heavier, more prolonged bleeding than expected.
A hematoma can also become infected. Most hematomas
will resolve by themselves. Rarely you may have to have
another operation so that the stitches can be opened to allow
a hematoma to drain.
• Constipation. Is a common short term problem and your
doctor may prescribe stool softeners or laxatives for this.
You should try to maintain a high fiber diet and drink plenty
of fluids to help as well.
• Bladder and bowel injury. There rare complications of
vaginal prolapse surgery.