Vaginal Repair

The doctor will tell you which area will be operated on - the cervix vagina, vulva, perineum and/ or perianal area, the doctor will tell you which of the following procedures will be done:

  • Removal of warts from the genital area. The doctor may cut them off or burn them off
  • Cervical cone biopsy, by scalpel or LLETZ (scooping the affected area from the cervix by diathermy) or by laser
  • Laser Treatment or electric diathermy (this destroys abnormal areas of tissue)

The condition

This procedure is usually performed for women who have problems holding onto urine (female incontinence).

Urinary incontinence affects 1 in 5 of women over the age of 40.  Incontinence refers to the leaking or passing of water (large or small amounts), without control.  This condition is caused by loss of bladder or urethra control, due to a number of different reasons or a combination of reasons.  Childbirth is a common cause for this problem.

The operation

Vaginal Repair
There are many different techniques (operations) used for management of female incontinence.  Ask your doctor to describe which operation you are having and the risks and outcomes of those risks.

Benefits of having the surgery

The decision to have surgery depends on the type of problems you are having and how bad they are.  You need to discuss this with your surgeon.

Risks of not having the procedure

This depends on the reason for the surgery.  If you have a prolapse, the uterus can drop down into the vagina and even outside the vagina where it can develop ulcers and cause considerable pain and discomfort

Specific risks of this procedure

  • Bleeding from large blood vessels.
  • Infection in the operation site or urinary tract.
  • Injury to other organs such as the ureter(s) (tube leading from kidney to bladder) bladder or bowel.
  • Difficulty passing urine immediately following surgery which is usually temporary but which may require a catheter to be reinserted into the bladder, or you may be taught to pass your own catheter until you are able to pass urine without assistance.
  • Stress incontinence of urine following surgery. Stress incontinence is a common condition where urine leaks when you cough, sneeze or perform various other activities involving abdominal straining. In this case, whilst no problem existed before surgery, often there is an unknown weakness of the bladder which leads to this problem when surgery is carried out.
  • A connection (fistula) may develop between the rectum and the vagina leading to leakage of faeces through the vagina (recto – vaginal fistula).
  • Pain in the perineum, which can last up to six weeks after surgery.  Change in bladder and bowel habits.  Pain during sexual intercourse.  Pain in the perineum (area between vagina and rectum).  Reccurrence of the original complaint (prolapse) with the passage of time.
  • Narrowing or shortening of the vagina.
  • Increased risk in obese people of wound infection, chest infection, heart and lung complications and thrombosis.
  • Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.

General risks of a procedure

There are risks with any operation, and these risks can happen with a vaginal repair.  They include:

  • Small areas of the lungs may collapse, increasing the risk of chest infection.  This may need antibiotics and physiotherapy.
  • Clots in the legs with pain and swelling.  Rarely part of this clot may break off and go to the lungs which can be fatal.
  • A heart attack because of strain on the heart or a stroke.
  • Death is possible due to the procedure but extremely rare.

Alternative treatment

Urinary incontinence

Exercise, changes to lifestyle, diet and weight reduction may assist in managing the problem.  Discuss with your doctor what may work for your condition.

Recovering from surgery

After the operation, the nursing staff will closely watch you until you have recovered from the anaesthetic.  You will then go back to the ward where you will recover until you are well enough to go home, usually about 2 days after vaginal surgery.

If you have any side effects from the anaesthetic, such as headache, nausea, vomiting, you should tell the nurse looking after you, who will be able to give you some medication to help.

Pain

You can expect to have pain in the operation site.  There are a number of ways in managing your pain. You may have:

  • A drip with painkillers into the spine, which deadens the area below your waist.
  • A drip with painkillers that you can give yourself when you feel pain.
  • Be given injections.

It is important that you tell the nursing staff if you are having pain.  Your pain should wear off within 7 - 10 days.  If it does not, you must tell your Doctor.

Diet

You will have a drip in your arm when you come back from surgery.  This will be removed when you are able to take food and fluids by mouth and you are no longer feeling sick.

It is not unusual to feel sick for a day or two after surgery.  Tell the nurse if this happens to you so that you can have drugs to stop it.  To begin with, you can have small sips of water, then slowly take more until you are eating normally.

Wounds

You may have a drain into the vagina, which will be removed after 24 to 48 hours following surgery.  You will have a very light blood loss from the vagina for 4 to 6 weeks after surgery.  If the bleeding is heavy – you must tell your doctor.

Bladder and bowels

You may come back from theatre with a tube into the bladder (catheter) to drain the urine into a plastic bag.  This is removed within a day or two of surgery.

You must not strain to make your bowels move.  The nursing staff will check with you daily until you have a normal bowel motion and, if you are having problems, they will give you some medicine to help.

Your lungs and blood supply

It is very important after surgery that you start moving as soon as possible.  This is to prevent blood clots forming in your legs and possibly travelling to your lungs.  This can cause death.

To help prevent clots forming in your legs, you will have support stockings (TEDS) on before you go to surgery and these will stay on until you are walking on your own.  You may also be put on drugs to thin your blood.

Also, you need to do your deep breathing exercises, ten deep breaths every hour, to get the secretions in your lungs moving and help prevent a chest infection.

At all costs, avoid smoking after surgery as this increases your risk of chest infection.

Exercise

Do expect to feel tired for sometime after surgery.  You need to take things easy and gradually return to normal duties, as you feel able to.  It usually takes about 6 weeks to recover and up to 6 months to feel back on top of things again.  You should not drive during the first 2 - 4 weeks – until you can brake suddenly without pain.

Do not lift heavy weights (over 2-3 kilos in weight) for at least six weeks after surgery.  This is to allow healing to take place inside.  You may have sexual intercourse about 6 weeks after surgery.

Tell your Doctor if you have:

  • Large amounts of bloody discharge from the vagina.
  • Fever and chills.
  • Pain that is not relieved by prescribed pain killers.
  • Swollen abdomen.
  • Leaking from the vagina.