Complications of PFR
- Hemorrhage—The hemorrhage may at times be brisk. The hypovolaemic state can be tackled by infusion and blood transfusion.
- Trauma — The bladder in anterior colporrhaphy or rectum in perineorrhaphy may be injured. The injury should be effectively repaired else, either VVF or RVF may develop later on.
- Retention of urine is a common complication. This is due to:
(i) Spasm, edema, and tenderness of pubococcygeus muscle.
(ii) edema of the urethral wall.
(iii) Reflex from the wounds.
- Infection leading to cystitis.
Primary hemorrhage occurs within 24 hours. It is due to imperfect hemostasis at operation or due to slipping of the ligature.
Along with the resuscitative procedures, the patient is to be brought to the operation theater. Under anesthesia, the suture sites in the vagina, both anterior and posterior are explored and hemostatic sutures are given. The vagina should be packed tightly with dry roller gauze which should be removed after 24 hours without anesthesia.
Secondary hemorrhage occurs usually between 5–10th day but may occur even in the 3rd week. It is due to sepsis of the wound. If the hemorrhage is brisk, along with resuscitative procedures, the patient is to be brought to the operation theater and under general anesthesia, the vagina is explored. The clots are removed to find any bleeding point. If only generalized oozing is found, tight intravaginal pack using dry roller gauze is enough. If bleeding point is visible, hemostatic sutures should be given followed by vaginal packing. The plug should be removed after 24 hours. Antibiotics are to be started again.
Sepsis: Infection occurs on the vaginal or perineal wounds. Rarely, disruption of the perineal wound occurs.
Late: - Dyspareunia
- Recurrence of prolaps
- VVF following bladder injury.
- RVF following rectal injury.
HOMOEOPATHIC MANAGEMENT OF INJURY TO THE VAGINA AFTER REPAIR:-
The medicines that can be thought of use are:-