What is it?
The vagina and the back passage - rectum are no longer held up properly. The rectum is dropping down onto the back of the vagina, making a weakness or bulge. The bulge is called a prolapse. A prolapsed rectum is called a rectocele. The prolapsed rectum may not empty properly when you want. The prolapse makes you feel uncomfortable in the vagina. The prolapse happens if the supports to the vagina and rectum stretch during pregnancy, and do not get back to normal afterwards. This may not show up until after the menopause. Having a heavy job, having a chronic cough, or being overweight will all bring on a prolapse earlier. An operation will tighten up the supports to the rectum, and take away the bulge in the vagina.
If you are taking the oral contraceptive pill, carry on and finish the packet you are using right past the time of your operation. If you have a coil (IUCD), this is best kept in until after the period following your sterilisation. It will stop any fertilised egg already in the tube, settling in the womb. Your coil can be taken out when the sterilisation is done if you use condoms. You must use them from the period before, to the period after the operation. This will stop fertilisation of any egg during this time. If you think your contraception may have failed, tell the doctor when you are in hospital. In itself, sterilisation is free from side effects. However, stopping using the pill, or having a coil taken out, may upset the periods for a month or two. Also long-term use of the Pill may have made the periods lighter. Sterilisation does not prevent you having the period problems that can crop up as you get older. At the time of your operation, the surgeon may see fibroids or other things that can lead to period problems after the sterilisation.
The operation
You will have a general anaesthetic and be completely asleep. The keyhole method is the most common. A small cut is made in the skin just below your tummy button. A narrow telescope called a laparoscope is passed through the tummy wall, and your tummy is inflated with some carbon dioxide gas. The two clips are put on the Fallopian tubes using a fine instrument which is passed in the tummy through a second keyhole which is close to the one used for the telescope. Finally, a stitch may be put into each skin wound. It usually takes about 15 minutes. It is dangerous to use the keyhole method if there are many scars inside from other operations. Also the laparoscopy is not safe if you have been pregnant very recently. The womb is in the way, and all the tissues bleed. If this is the case, small cut is made in the lower part of your tummy. The Fallopian tubes are blocked by taking out a short length of each one and closing off the ends with a stitch. The operation can usually be done as a day case.
Any alternatives
By this stage, you will surely have tried and ruled out the Pill, the coil, condoms, and injection treatment. Waiting until the youngest child is over one year old is often a sensible plan. Sterilisation of the male partner - vasectomy is worth thinking about. It is more reliable than female sterilisation. It can be done with just local anaesthetic to numb the skin. It takes about three months to work. It is very difficult and expensive to join the ends up again, with about 1 in 3 chance of success. Some men do just not like the idea of a vasectomy. You need to decide with your partner on the best way for you to go ahead.
Before the operation
Stop smoking and get your weight down if you are overweight. (See Healthy Living). 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 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
If you have had the keyhole operation you may have a sanitary pad in place. You may have some discomfort in the tummy and shoulders caused by the gas inside the tummy. After three or four hours on the ward, you should feel fit enough to go home. 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 can do things for yourself. Do not make important decisions, drive a car, use machinery, or even boil a kettle during that time. A note will be sent to your General Practitioner. You should not need any check up. If you feel that all is not well, telephone the ward. The nurses will advise about sick notes, certificates etc.
After - at home
Make sure you are going home by car with your relative or friend. At home, rest for at least six hours. Take the dressing off the wound while in the bath or shower after three days and although you can shower or bath try to keep the wound(s) dry for a week. You will be advised about the stitches. There may be slight bleeding from the vagina, like the end of a period. It will last for a few days. Only use external pads for any loss. Do not use tampons. You can usually go back to normal activity and work after a week. Avoid heavy exercise for a week. You can have sex after your next natural period if you feel comfortable enough.
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.
All operations have some risks. Laparoscopy is a very common and safe operation. However, complications can occur in 1-2% of cases. Very rarely bleeding can occur during the operation. Even more rarely, the bowel can be damaged by the instruments. In either case, the problem can be dealt with straight away through a bigger wound. Sometimes, there is some infection in the tummy button area after the operation. This settles down with antibiotics.
General advice
We hope these notes will help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.
