Cystocele Repair

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KEY POINTS

• Cystocele repair is surgery to lift and tighten the tissue around the bladder so that it no longer pushes into the vagina.
• The surgery is done to relieve leaking of urine, bladder infections, and pain during sex caused by the bladder bulging into the vagina.
• Ask your provider how long it will take to recover and how to take care of yourself at home.
• Make sure you know what symptoms or problems you should watch for and what to do if you have them.

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What is cystocele repair?

Cystocele repair is surgery to lift and tighten the tissue around the bladder so that the bladder no longer pushes into the vagina.

When is it used?

A cystocele happens when the bladder pushes against weakened tissue in the vagina and drops down into the vagina. It may cause leaking of urine, bladder infections, and pain during sex. Surgery may be done to relieve these symptoms. After the surgery you should be able to urinate normally again. You may be able to go back to your usual activities without leaking urine. Bulging and feelings of pressure in the vagina will be relieved. Sex should be more comfortable.

If your rectum also bulges into the vagina, causing problems with bowel control (a problem called a rectocele), both conditions may be repaired at the same time.

Instead of or in addition to this procedure, other treatments to relieve symptoms may include:

• Lifestyle changes, such as changes in diet, weight loss, or avoiding strenuous activities
• Kegel exercises to strengthen the pelvic muscles
• A pessary, which is a silicone or plastic device prescribed by your healthcare provider. It’s inserted into the vagina to help support the uterus, bladder, and rectum.
• Surgery to remove the uterus (hysterectomy)

Surgery is usually done only after you have tried other treatments. Ask your healthcare provider about your choices for treatment and the risks.

How do I prepare for this procedure?

• Make plans for your care and recovery after you have the procedure. Find someone to give you a ride home after the procedure. Allow for time to rest and try to find other people to help with your day-to-day tasks while you recover.
• Follow your provider's instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly. It is best to quit 6 to 8 weeks before surgery.
• You may or may not need to take your regular medicines the day of the procedure. Tell your healthcare provider about all medicines and supplements that you take. Some products may increase your risk of side effects. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• Tell your healthcare provider if you have any food, medicine, or other allergies such as latex.
• Your provider will tell you when to stop eating and drinking before the procedure. This helps to keep you from vomiting during the procedure.
• Your provider may ask you to take an enema or medicine to clean out your bowel before surgery.
• Follow any other instructions your healthcare provider gives you.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do.

What happens during the procedure?

The surgery will be done at the hospital.

You will be given a regional or general anesthetic to keep you from feeling pain. Regional anesthesia numbs part of your body while you stay awake. If you have regional anesthesia, you may also be given medicine to help you relax. General anesthesia relaxes your muscles and puts you into a deep sleep.

Your healthcare provider will make incisions (cuts) in the wall of the vagina. Your provider will create support for the bladder by sewing folds of your own tissue around it. Stretched or extra tissue around the bladder may be removed.

If leaking urine has been a problem, your provider may use a graft (piece of synthetic mesh or natural material) to cradle and lift the urethra and bladder. This is called an elevation or suspension procedure.

The cuts in the vagina will then be sewn closed.

Your provider may put a catheter (tube) into your bladder to drain urine. The catheter may pass through the urethra (the tube that carries urine out of the body) or your provider may insert it into the bladder through a cut in the wall of your lower belly. This will help you pass urine while you are recovering. It will also decrease pressure inside your bladder.

What happens after the procedure?

You may stay in the hospital 2 to 4 days.

You may need to go home with a catheter in your bladder until the bladder is working normally again. Your healthcare provider will decide when the catheter can be removed during a follow-up visit.

Constipation is common after surgery because of some medicines and inactivity. Eating fruits and vegetables and drinking extra fluids may help you avoid constipation. If diet and extra fluids are not enough to avoid constipation, your provider may recommend a stool softener or a laxative. Check with your healthcare provider if constipation keeps being a problem.

You may have some bloody or pink drainage from your vagina for a few weeks.

Ask your healthcare provider:

• How long it will take to recover
• If there are activities you should avoid, including how much you can lift, and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

What are the risks of this procedure?

Every procedure or treatment has risks. Some possible risks of this procedure include:

• You may have problems with anesthesia.
• You may have infection, bleeding, or blood clots.
• The bladder, ureters (the tubes from the kidneys to the bladder), or urethra may be damaged. If damage occurs and your provider is aware of it, he or she will try to repair it during the operation.
• You may keep leaking urine.
• You may have a constant feeling that you need to urinate.
• You may have problems urinating.
• The cystocele may come back.

Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.