Cystocele and Rectocele Repair

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

En Espaol (Spanish Version)

Definition

A cystocele occurs when part of the bladder wall bulges into the vagina. The bulge happens through a defect in the fascia , or connecting tissue, that separates the vagina from the bladder. A bulge of this type is called an anterior prolapse . Women who have a cystocele may experience symptoms such as stress incontinence (urine leakage), incomplete bladder emptying, pain during sexual intercourse, and a sensation of something bulging into the vagina.

Cystocele

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2008 Nucleus Medical Art, Inc.

A rectocele occurs when part of the wall of the rectum bulges into the vagina. The bulge happens through a defect in the fascia between the rectum and vagina. This is called posterior prolapse. Women who have a rectocele may also experience the sensation of something bulging into the vagina. They may also have difficulty initiating a bowel movement. They may even find that they must split, or insert fingers into the vagina to hold back the bulge, in order to complete a bowel movement.

Rectocele

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2008 Nucleus Medical Art, Inc.

Both cystoceles and rectoceles are types of hernias . They indicate problems with pelvic support tissues (fascia, ligaments and muscle).

Parts of the Body Involved Cystoceles involve the following: VaginaBladderMuscle and tissue separating and supporting the bladder and vaginaRectoceles involve the following:VaginaRectumMuscle and tissue separating and supporting the rectum and vagina Reasons for ProcedureUsually, surgery to repair a cystocele or rectocele is not performed unless other treatments have not been effective. Other treatments include muscle strengthening exercises, such as Kegels, and the insertion of a pessary device. A pessary is a flexible device that supports the vaginal walls, so the cystocele or rectocele no longer bulges into the vagina.If you have tried either or both of these treatments and experienced no relief, your physician may suggest surgical repair as another option. Surgical repair of the cystocele or rectocele can result in improved bladder or bowel control. You may find that you no longer have problems with stress incontinence and can resume activities you did not feel comfortable doing before. Surgery can also relieve pain you may have experienced during sexual intercourse. Risk Factors for Complications During the ProcedureIf you have had previous problems with cystoceles or rectoceles, the surgery may be less effective in correcting these problems this time.
What to Expect Prior to ProcedureEat a light meal the evening before the surgery.Do not have anything to eat or drink after midnight on the night before or morning of the procedure. Do not even have water (unless specifically permitted by your doctor or anesthesiologist).Follow any instructions provided by your physician.If you are having a rectocele repair, your physician may administer an enema or ask you to administer an enema the night before the surgery. AnesthesiaYou will often have your choice of either general anesthesia or regional (epidural / spinal) anesthesia. Talk with your surgeon and anesthesiologist about which would be a better choice for you. Description of the ProcedureYour physician will make an incision (cut) into the appropriate vaginal wall to expose the fascia and muscle underneath. He or she will then operate on this tissue to help strengthen it. In some cases, the tissue is sutured, or sewn, back onto itself in order to make it stronger. In others, a mesh-type material is used to strengthen the tissue. At this time, the doctor will also remove any tissue that has been weakened by previous surgeries, pregnancies, or age, as well as any excess vaginal lining.If you have experienced severe incontinence problems, the doctor may also perform a suspension or elevation procedure to help support the bladder.
If the uterus is also prolapsing downward into the vagina, a hysterectomy may be done. Typically, a bladder catheter will be inserted in your urethra at the beginning of the operation to help relieve pressure on the bladder. After ProcedureIf you had rectocele repair alone, the medicated vaginal packing is usually left in the vagina overnight, and the bladder catheter will be removed as soon as you are able to empty, usually before discharge from the hospital.If you had cystocele repair, the medicated vaginal packing is also usually left in place overnight, but the bladder catheter often needs to stay in longer (sometimes 2-6 days) in order to allow the bladder time to begin functioning normally again.You may notice a possibly smelly, even bloody, discharge from the vagina for 1-2 weeks. How Long Will It Take?The surgery itself can take anywhere from 45 minutes to 2 hours or more. The length depends on the repairs that need to be made. Will It Hurt?You will likely experience vaginal discomfort for 1-2 weeks following the surgery. You will typically be given a prescription for medication to help relieve this discomfort. Possible Complications Some risks associated with cystocele and rectocele repair include the following:
Adverse reaction to anesthesiaInfectionHeavy bleedingAccidental damage to vagina, rectum, and bladderAccidental damage to nearby organsAccidental injuries during these procedures are extremely rare. In the unlikely event that an injury did occur, the doctor would usually fix the problem during the surgery. Average Hospital StayYour hospital stay may range from 2-6 days or more. The length depends on your individual situation. Postoperative CareAvoid lifting anything that weighs more than 10 pounds for about a month.Avoid sexual intercourse for about a month.Avoid inserting anything into the vagina (eg, tampons) for about a month.Have someone to help you at home for a few days following the surgery. OutcomeTypically, women who have had cystocele or rectocele repair find that they have much improved bladder or bowel control. Call Your Doctor If Any of the Following OccursAny signs of infection, such as fever, chills, or foul-smelling discharge from the vaginaUnusually heavy vaginal bleedingWorsening painAny unusual symptoms RESOURCES: American College of Obstetricians and Gynecologistshttp://acog.org National Kidney and Urologic Diseases Information Clearinghousehttp://kidney.niddk.nih.gov CANADIAN RESOURCES: Canadian Urological Association
http://www.cua.org The Society of Obstetricians and Gynaecologists of Canada (SOGC)http://www.sogc.org References: DeLancey JO. Functional anatomy of the female pelvis. Female Urology . Philadelphia, PA: JB Lippencott; 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 March 2008 by Ganson Purcell Jr., MD, FACOG, FACPEPlease 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.
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