An anterior and posterior repair, often called an A&P repair, is a surgical procedure performed to correct pelvic organ prolapse. This condition occurs when the supporting tissues of the pelvic floor weaken, allowing organs to fall or bulge into the vaginal space. Specifically, an anterior repair addresses a cystocele, which is a prolapse of the bladder into the front of the vagina. A posterior repair corrects a rectocele, which is a prolapse of the rectum into the back of the vagina.
The Immediate Post-Operative Experience
The first 24 to 48 hours after an A&P repair are spent under direct medical supervision in the hospital or surgical facility. Patients typically wake up with an intravenous (IV) line for fluid and pain medication management. Nursing staff closely monitor vital signs and manage initial discomfort to ensure a stable transition out of anesthesia.
A temporary urinary catheter is commonly placed during the procedure to keep the bladder completely empty, protecting the surgical repair site from strain during the initial healing phase. The catheter is usually removed within a day or two, and a critical step before discharge is confirming the ability to fully empty the bladder on one’s own. If there is difficulty voiding, which is a common temporary issue, patients may need to be taught self-catheterization or have the indwelling catheter replaced for a few extra days.
Once the medical team is satisfied with bladder function, IV pain medications are transitioned to oral tablets. Most people stay in the hospital for one or two nights before being cleared to go home. Before leaving, patients receive prescriptions for pain relief and instructions on when to switch to over-the-counter options as the pain subsides.
Navigating Early Home Recovery
The first four to six weeks at home are crucial for the success of the repair, as internal stitches dissolve and tissues gain strength. The primary focus is avoiding any activity that increases pressure within the abdomen, which can strain the newly repaired pelvic floor. This means an absolute restriction on heavy lifting, generally defined as anything heavier than a gallon of milk or an object requiring two hands to lift.
Preventing straining during bowel movements is a major concern due to the posterior repair. Surgeons recommend a high-fiber diet, increased fluid intake, and consistent use of stool softeners to ensure easy passage and avoid putting pressure on the rectal repair site. It is normal to experience some vaginal spotting or a watery, yellowish discharge for up to six weeks as the absorbable sutures dissolve and exit the body.
While showering is permissible immediately, baths, hot tubs, or swimming should be avoided until cleared by the surgeon to prevent infection. Similarly, nothing should be inserted into the vagina, including tampons, during this healing phase. Short, frequent walks around the house or yard are encouraged from the beginning to promote circulation and aid in preventing blood clots.
Resuming Normal Activities and Long-Term Expectations
The six-week post-operative follow-up appointment is where the surgeon assesses healing and provides clearance for resuming many normal activities. Sexual activity should not be attempted until the surgeon confirms the vaginal incisions are completely healed. Returning to sexual function often improves quality of life, and studies show that dyspareunia, or painful intercourse, often decreases after successful prolapse repair.
The return to exercise is a gradual process, beginning with light activities like walking. Strenuous activities, such as running, jumping, or heavy weightlifting, must be reintroduced slowly and only after the initial six-week restriction is lifted. The risk of prolapse recurrence is a long-term reality, with rates estimated to be around 20 to 30% over many years.
Long-term maintenance focuses on minimizing future strain on the pelvic floor to reduce the chance of recurrence. Maintaining a healthy weight and committing to proper lifting techniques are important lifestyle adjustments. Lifelong adherence to pelvic floor muscle exercises, often called Kegel exercises, helps maintain the strength of the supportive muscles surrounding the repair sites.
Recognizing Potential Post-Surgical Concerns
While discomfort and light spotting are expected, certain symptoms warrant immediate contact with the healthcare provider. A persistent fever above 100.4 degrees Fahrenheit, new or significantly increased localized pain, or a foul-smelling vaginal discharge can signal a developing infection. Any bleeding that soaks a sanitary pad in one hour or less is considered excessive and requires urgent medical attention.
Severe pain not relieved by the prescribed narcotic medication must be reported immediately. Difficulty or the complete inability to urinate after catheter removal is a serious concern indicating a problem with bladder function that requires prompt evaluation. Swelling, redness, or tenderness in one or both legs could indicate a deep vein thrombosis (DVT), which is a time-sensitive issue.