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Anterior Repair


What is it?

The bladder and the vagina are no longer held up properly. The bladder is dropping down onto the front of the vagina, making a weakness or bulge. The bulge is called a prolapse. A prolapsed bladder is called a cystocele. The prolapsed bladder may not empty properly when you pass urine. The prolapse makes you feel uncomfortable in the vagina. You may also feel as if the bladder is full all the time. The prolapse happens if the supports to the bladder and vagina stretch during pregnancy and do not get back to normal properly afterwards. This may not show up until after the menopause. Having either a heavy job, a chronic cough, or being overweight will all bring on a prolapse earlier. An operation will tighten up the supports to the bladder and take away the bulge in the vagina.

The Operation

You will have a general anaesthetic and be completely asleep. A cut is made through the lining of the front (anterior) wall of the vagina. The supports to the bladder are shortened with stitches and the bulging part of the vagina cut away. This repairs the weakness. The wound in the vagina is then stitched up. You need to be in hospital for about six to seven days.

Any Alternatives

If you leave things as they are, the prolapse will slowly get bigger. Your discomfort and feeling of a full bladder will worsen. The bulge may even drop through the vaginal opening and start to bleed. A prolapse is not a life-threatening condition but it can seriously effect the quality of your life.The operation to fix it is relatively easy to do and works well most of the time. The best way forward is to have the operation.

Before the operation

If you are past the menopause, your vagina may be short of the female hormone oestrogen. You will heal better if you have some hormone replacement treatment (HRT). You may be started on this before your operation using tablets, patches, or a vaginal cream. This will be for a month or two to cover the operation only. You don’t need to decide at this stage about having long-term HRT. Stop smoking and get your weight down if you are overweight. If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to hospital with you. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. . Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

After - In Hospital

You will have a sanitary pad in place. The wound can be a little painful. You may have a button switch (PCA Patient Controlled Analgesic) on your wrist to press when you have pain. This gives you a small dose of a pain relieving drug into a vein. You may be given injections by the nurses for the pain. If the pain is still there, tell the nurses. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions during that time. .The next day, all you will need for the pain is tablets. You will have some blood and urine tests after your operation. These will check you are not anaemic and have no infection in your urine. You may continue your course of HRT to cover the next month or two. You may have a tube or catheter draining the bladder for a few days. The catheter will make you feel as though you need to pass urine. This is a false alarm. If you do not have a catheter, you need to pass urine within six hours after the operation. If you have any difficulty, tell the nurses. You should wear pads as dressings. Do not use tampons for six weeks. There are stitches in the skin wound in the vagina. The parts of the stitches under the skin will melt away by themselves. The surface knots of the stitches will appear on the pads after about two weeks. This is quite normal. There will be slight bleeding like the end of a period. It should be almost nil by the time you leave hospital. There may be a little bleeding again after about two weeks when the knots become free. This is nothing to worry about. The hospital may arrange a check up about one month after you leave hospital. The nurses will advise about sick notes, certificates etc.

After - At Home

At home, you are likely to feel tired and need rest two or three times a day for three to four weeks. You will gradually improve. After three months, you should be able to return completely to your usual level of activity. You can drive as soon as you can make an emergency stop without discomfort, generally after three weeks. You can start sexual relations before you return for your six week check, if you feel comfortable enough, and you have no blood loss. You should be able to return to a light job after about six weeks and to a heavy or busy job after about 12 weeks.

Possible Complications

As with any operation under general anaesthetic there is a very small risk of complications related to your heart or you lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

Most vaginal repairs are without complications. Minor complications occur in 3 to 4% of cases. If you think that all is not well, please ask the nurses or doctors. Sometimes the bladder is slow to start working again. Be patient. Sometimes the catheter needs to go back into the bladder for a few days. Wound infection is sometimes seen. This settles down with antibiotics in a week or two. Aches and twinges may be felt in the vaginal area for up to three months.

More serious complications such severe bleeding, damage to your bowel by the operation, or a creation of a passage between your vagina and the bowel (fistula) are rare (1-2% of cases) and may require another operation to fix them.

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