Colpocleisis is a surgical procedure that’s used to treat uterine prolapse in women. In prolapse, muscles of the pelvic floor that support the uterus and other pelvic organs weaken, causing the uterus to hang down into the vagina, creating a bulge.
Prolapse of the uterus can create a feeling of pressure or heaviness in the lower belly. It can affect the quality of life, making urination difficult and sexual intercourse painful.
Surgery to treat prolapse is usually performed when other less invasive treatments don’t help. There are two main types of surgeries to treat uterine prolapse:
- Obliterative or occlusive surgery: This type of surgery involves narrowing, shortening, and/or closure of the vagina to support the pelvic organs.
- Reconstructive surgery: This type of surgery involves removal of the uterus by detaching it from the upper portion of the vagina, fallopian tubes, ovaries, surrounding blood vessels, and connective tissues that support it before removing the uterus. The cervix may be removed as well. The rest of the organs are repositioned back into the pelvis, including the vagina.
Colpocleisis is a type of obliterative/occlusive surgery, where the surgeon sutures (stitches) the front and back walls of the vagina together to shorten the vaginal canal. This provides support to the uterus. The surgery is irreversible. Colpocleisis is less invasive than reconstructive surgery and done through the vagina, whereas reconstructive surgery is performed through an incision over the abdomen. Hence, the recovery after colpocleisis is faster. Colpocleisis has a high success rate, but it is usually reserved for older women who are no longer sexually active because, after colpocleisis, the vagina is too short and narrow to be able to have vaginal intercourse.
Who undergoes colpocleisis?
Surgery for uterine prolapse is usually performed when women don’t show improvement with other non-invasive treatment options. Because colpocleisis is less invasive than reconstructive surgery, it is preferred in patients who have systemic medical conditions and are hence unfit for more extensive surgeries. This procedure is usually recommended for older, post-menopausal women who are no longer sexually active and don’t wish to be sexually active in the future either. Women will not be able to have vaginal intercourse after colpocleisis because the vagina would be too narrow. The surgery also prevents access to the cervix and uterus; hence, performing a pap smear of the cervix and other diagnostic tests of the uterus or fallopian tubes would not be possible.
How is a colpocleisis procedure performed?
During surgery:
The surgery is usually performed under general anesthesia or spinal anesthesia (anesthesia below the level of the waist). Hence, there will not be any pain during surgery. The surgeon sutures (stitches) the anterior (front) and posterior (back) walls of the vagina together to shorten the vagina. The sutures used are absorbable and get absorbed in a few months. The surgery usually takes around an hour. A catheter may be placed in the bladder to drain out urine, which may be removed after 24-48 hours, so the patient would not have to walk to the bathroom.
After surgery:
Patients are usually discharged 24-48 hours after the surgery. The urinary catheter is removed before discharge. Patients may have to wear compression stockings while on bed rest to prevent the formation of blood clots in the blood vessels. Painkillers and antibiotics would be prescribed. Patients experience bloody vaginal discharge for a few days to weeks after the surgery, for which they would need to wear sanitary pads. The recovery period after colpocleisis is usually shorter and less painful compared with that after reconstructive surgery. Patients can resume their daily activities a few days to a few weeks following surgery, after consulting with the surgeon. Patients are advised to avoid lifting heavy objects or rigorous exercises for up to six weeks. Complete recovery may take six to eight weeks. Patients can urinate and defecate normally after surgery, but they would not be able to engage in vaginal intercourse.
What are the complications of a colpocleisis procedure?
Colpocleisis is relatively safe, but like any surgery, there is a risk of complications. They include:
- Bleeding
- Infection
- Blood clots in the blood vessels
- Damage to the surrounding organs, muscles, nerves, and other tissues
- Reaction to anesthesia
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