Posterior Repair

What is a posterior repair?

A posterior repair is a surgical procedure designed to treat a prolapse of the back wall of your vagina, also known as a rectocele. This condition occurs when the rectum bulges into the vaginal wall due to weakened or stretched pelvic floor muscles and tissues. It can cause discomfort, pressure, and difficulties with bowel movements. A posterior repair strengthens and supports the vaginal wall, restoring its normal position and relieving symptoms.

Why might you need a posterior repair?

A rectocele can develop for various reasons, including childbirth, menopause, ageing, or frequent heavy lifting, all of which can weaken the pelvic floor. You may benefit from a posterior repair if you experience:

• A feeling of pressure or heaviness in your vagina
• A noticeable bulge in your vaginal area
• Difficulty fully emptying your bowels or needing to press on the vaginal wall to do so
• Constipation or frequent straining during bowel movements
• Discomfort or pain during intercourse

If these symptoms are significantly affecting your quality of life and other treatments, such as pelvic floor exercises, have not been effective, surgery may be recommended by your doctor.

What happens during the procedure?

A posterior repair is typically performed under general or regional anaesthesia. During the procedure, your surgeon will make a small incision in the back wall of your vagina to access the weakened tissue. They will then tighten and repair the tissues supporting the vaginal wall and rectum, removing any excess or stretched tissue. Once the repair is complete, the incision will be closed with dissolvable stitches.

The procedure usually takes about an hour to complete. Depending on your individual circumstances, you may be able to go home the same day or after an overnight stay in the hospital.

Recovery after posterior repair

Recovery from a posterior repair varies from person to person, but most women can return to their normal daily activities within 4–6 weeks. However, you will need to follow certain precautions during this time to ensure proper healing:

• Avoid heavy lifting, strenuous activities, and high-impact exercises for at least 6 weeks.
• Take short, gentle walks to promote circulation and aid healing.
• Follow your doctor’s instructions for caring for your stitches and managing any discomfort.
• Avoid inserting anything into your vagina, including tampons, and refrain from sexual intercourse until your doctor advises it is safe.

It is normal to experience some light vaginal bleeding or discharge during the first few weeks after surgery. This should gradually improve as you heal. Your doctor will schedule follow-up appointments to monitor your progress and ensure your recovery is on track.

Benefits of posterior repair

A posterior repair can significantly improve your quality of life by addressing symptoms such as vaginal pressure, discomfort, and bowel difficulties. Many women find relief from the discomfort and regain confidence in their daily activities after the procedure.

Risks of posterior repair

As with any surgical procedure, there are risks involved. While complications are rare, they can include:

• Infection or bleeding
• Pain or discomfort during intercourse
• Temporary difficulty with bowel movements during recovery
• A small risk of prolapse recurrence in the future

Your consultant will discuss these risks with you and provide guidance on how to minimise them. They will also ensure you have all the information you need to make an informed decision about the procedure.

Lifestyle changes to support your pelvic floor

In addition to surgery, maintaining a healthy lifestyle can help support your pelvic floor and prevent further issues. Your doctor may recommend:

• Pelvic floor exercises to strengthen the muscles supporting your bladder, bowel, and vagina
• A balanced diet high in fibre to prevent constipation and reduce straining
• Staying hydrated to support healthy bowel movements
• Avoiding heavy lifting and high-impact activities that could strain your pelvic floor

By combining these lifestyle changes with the benefits of a posterior repair, you can improve your overall pelvic health and quality of life.