Rectocele: a bulging of the bowel wall towards the vagina is called a rectocele. Cystocele: a downward displacement of the bladder is called a cystocele. What are the symptoms of rectocele and cystocele?
- Urinary incontinence
- Passing urine frequently
- A strong urge to pass urine
- A feeling of pressure
- Bulging of the vagina
- Inability to control wind (gas)
- Constipation
- Back and pelvic pain (note that inability to control wind and constipation are symptoms of rectocele only). What causes cystocele and rectocele?
Causes of this condition include obesity, chronic coughing, straining when opening the bowels, and difficult childbirth. Prevention: exercises to strengthen the perineum (Kegel exercises), especially after childbirth, prevent prolapse.
Treatment: this condition is treated with reconstructive (repair) surgery.
Before the operation
- Have soup on the night before the operation, and have nothing to eat or drink from midnight.
- On the night before the operation, a bowel wash or bowel preparation (enema) and a vaginal wash or preparation will be done for you to reduce contamination during the operation. So it is best to have a bath on the night before the operation and to shave the surgical area (perineum) completely. This reduces the risk of infection.
- If you have a particular illness for which you are being treated, tell your doctor and nurse, because in some cases your medicine may need to be stopped temporarily or replaced with other medicines.
- Remember that on the day of the operation you must remove all metal objects, including jewellery and hair clips, as well as contact lenses and any artificial body parts, and then put on the special operating theatre gown.
- Lack of movement after the operation can cause blood to pool (clot) in the legs and increase the risk of lung infection, so do the breathing exercises and leg rotations you have been taught straight after surgery.
Education and care after surgery
- Eating after the operation: you must not eat anything on the first day. Once the nurse allows you, you will start on a liquid diet, and gradually, with the doctor's approval, you can eat other foods. To prevent constipation and pressure on the stitches, drink plenty of fluids, eat high-fibre foods (vegetables and fruit), walk, and use stool softeners as instructed by your doctor.
- Getting out of bed: when you are allowed to leave your bed, first sit on the edge of the bed for a while with your legs hanging down; if you do not feel dizzy, you can walk with the nurse's help.
- Care of the operation site: after each time you pass urine or open your bowels, rinse the operation area with lukewarm, sterile saline solution and pat it dry with a clean disposable tissue. To dry the operation area and speed up healing, you can use a hairdryer held 30 centimetres away.
- Preventing urinary infection: after opening your bowels, wash the perineal area from front to back.
Wear cotton underwear and change it often; after washing, dry it in the sun or iron it. When you feel the need to pass urine, do so straight away. Preventing urinary incontinence: before the urinary catheter is removed, the nurse will close and then open the catheter several times to prevent incontinence. As urine collects, you may feel pressure in your bladder, which is normal.
Resuming sexual intercourse: the stitches take one to two weeks to heal well, but it is better to avoid intercourse for 1.5 months. Note that if there is any bloody discharge, it is better not to have intercourse. 7. Resuming daily activities: 2 weeks after surgery you can resume your daily activities, but avoid standing for long periods and lifting heavy objects.
8. Exercise after the operation: you should do the perineal (Kegel) exercise you have been taught at home. This exercise is very simple. In any position – sitting, standing or lying down – simply tighten the muscles between the urinary opening and the anus, drawing them inwards, hold this (contracted) position for 30 seconds, and then relax.
Do this exercise 10 to 20 times a day. For the effects of the exercise to be noticeable (visible), you need to keep doing it for at least 6–12 weeks. 9. Visiting your doctor or the hospital: see your doctor at their surgery one week after discharge. If you have sudden pain, increasing pain or bleeding, you must go to the hospital immediately.
Prepared and compiled by: Homa Yektapour – Education Unit
Source: Williams Gynaecology and Obstetrics
Document code: NO-BR-21