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During surgery, the repair of the vaginal wall consists of folding over and then suturing the existing tissue between the vagina and bladder to strengthen it. [1] [11] This tightens the layers of tissue to promote the replacement of the pelvic organs into their normal place. The surgery also provides more support for the bladder.
A cul-de-sac hernia (also termed a peritoneocele) is a herniation of peritoneal folds into the rectovaginal septum (in females), [2] or the rectovesical septum (in males). The herniated structure is the recto-uterine pouch (pouch of Douglas) in females, [2] or the rectovesical pouch in males.
When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the small intestine and the skin it is known as an enterocutaneous fistula, and between the colon and the skin as a colocutaneous fistula. [3] A fistula can result from an infection, inflammation, injury or surgery. [5]
The most direct consequence of an obstetric fistula is the constant leakage of urine, feces, and blood as a result of a hole that forms between the vagina and bladder or rectum. [20] This leaking has both physical and societal penalties. The acid in the urine, feces, and blood causes severe burn wounds on the legs from the continuous dripping. [21]
Rectovaginal fistulas are often the result of trauma during childbirth (in which case it is known as obstetric fistula), with increased risk associated with significant lacerations or interventions are used such as episiotomy or operative (forceps/vacuum extraction) deliveries [2] or in situations where there is inadequate health care, such as in some developing countries.
Among women with chronic pelvic pain, the most common comorbidities are endometriosis (70%), postpartum pelvic pain (44%), bladder pain syndrome (61%) and irritable bowel syndrome (39%).
Prior to surgery, the bowels are typically cleared with a routine called bowel prep. [20] Bowel prep can be performed at home the 1–2 days before surgery or in some instances, occurs in a hospital before the operation. [20] Bowel prep may require magnesium citrate drink to empty the colon. [21] Bowel prep is done to reduce infection risk. [22]
According to the Cleveland Clinic, between 6% and 8% of people who have had surgery to remove their prostate will develop some type of urinary incontinence, but it is usually temporary.