Perineal Reconstruction

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What is perineal reconstruction?

Perineal reconstruction is an operation to strengthen the area between the vagina and back passage. This area is known as the perineum. It is also called the perineal body, hence the name perineal body reconstruction. It can become deficient after delivery.

Why do I need this kind of surgery?

Perineal reconstruction is often recommended to improve a deficient perineum, so as to improve the quality of life.

What can I expect before the operation?

You will be invited for pre-op assessment, when the nursing staff will go through your hospital stay and explain your operation. Please do let us know about any concerns you have or if there is any information you think we should know about that will make your stay with us more comfortable.

You will need to make arrangements for your family, children or any other commitments that you have prior to coming in to hospital and to cover the length of your recovery.

On admission, the nursing staff will go through your stay on the ward again to ensure you feel comfortable whilst in the hospital.

You will see an anaesthetist and the doctor performing the surgery before you go to theatre. It is not unusual to feel anxious; the nursing staff will gladly discuss how you are feeling and talk you through your emotions.

If you have not already signed the consent form when your operation was agreed and booked, the doctor will go through it with you before you go to theatre.

What does the operation involve?

The operation is done through the vagina. Stitches are used to reconstruct the perineum and the edges of the cut in the vaginal wall are then approximated with sutures. A gauze pack may be left in the vagina, to avoid bruising.

The operation can be done under general anaesthesia, spinal anaesthesia or local anaesthesia, with or without sedation. The choice will depend on your preferences and other factors, such as whether you are breast feeding or not.

What are the risks?

There are risks with any operation but these are minor, as the operation is relatively minor. The main risks associated with these operations are:

Common risks:

• Postoperative pain. You will be provided with pain killers
• Wound infection, which may need antibiotics
• Wound bruising, breakdown and delayed wound healing

Uncommon risks:

• Venous thrombosis and pulmonary embolism (blood clot in leg/lung). These are reduced by elastic stockings and injections that thin the blood to prevent clots
• The operation may fail and the perineum may remain weak. This may need repeat operation, though this is rare
• Over tightening may lead to the entrance to the vagina becoming tight. Time is allowed and lubrication as well as vaginal dilators might be tried. Sometimes, surgery might be required to correct the tightness, though this is rare
• Bleeding requiring blood transfusion
• Return to theatre e.g. because of bleeding
• Injury to bowel, though this rare. If the injury happens and is detected, it is repaired at the time

In order for you to make an informed choice about your surgery please ask one of the doctors or nurses if you have any questions about the operation before signing the consent form.

What can I expect after the operation?

As you come round from the anaesthetic you may experience episodes of pain and / or nausea. Please let the nursing staff know and they will assess you and take appropriate action.

You may have a pack in the vagina, to stop any bleeding, or a dressing over the wound. The pack or dressing will be removed before you go home.

You will have a drip to give you fluids, though you will be able to eat and drink. It is not unusual to experience lower back pain and a feeling of fullness in your bowel and generalised discomfort when sitting.

We use a pain score to assess your pain: 0 to10: 0 = No Pain, 10 = Very Strong Pain.

Your nurse will be checking your blood pressure, pulse, respirations and temperature and monitor any vaginal bleeding. S/he will also ask you to move from side to side and to do leg and breathing exercises once you are able, this will help prevent any pressure damage, a DVT (deep vein thrombosis) or chest infection.

What about going home?

The operation is usually carried out as a day case. You will be encouraged to sit up and start to walk, when you feel comfortable. You will be able to go home when you are passing urine without difficulty.

Please feel free to ask questions about your operation and recovery at any time.

The nursing team will discuss your convalescence. To ensure you have a good recovery you should take note of the following:

What about follow up?

A follow up can be arranged, if required. This is usually organised for 12 weeks after surgery.

If you have problems, you can either contact your doctor or contact the hospital to arrange for an appointment or bring an arranged appointment forwards.

Are there any alternatives to this kind of surgery?

You might have been offered, and may have tried, pelvic floor muscle training with physiotherapy before opting for surgery.

Who can I contact with any concerns or questions?

You should contact your doctor or the hospital if you notice increased temperature, wound swelling and/or pain, smelling discharge either from the wound or the front passage, blood in urine or motion, abdominal distension and/or failure to open your bowel.

If you have any problems or questions, you can contact: