What is a posterior repair?
Posterior repair is a procedure to repair a weakening of the tissue at the back wall of the vagina (the rectocele). It is performed through a vaginal incision.
The posterior prolapse often results in bowel movement difficulties, as well as a dragging or full feeling and an uncomfortable bulge, which can extend down beyond the opening of the vagina.
What does the operation involve?
A cut is made at the back of the vagina, and the layer of supporting tissue (the fascia) that divides the vagina and the rectum is identified. This layer is repaired using dissolvable stitches, which take six to eight weeks to dissolve. If there is excessive vaginal skin, this may be removed. The operation takes about 30 minutes.
At the end of the operation, a catheter and vaginal pack may be inserted which are normally removed within 24 hours. The vaginal pack helps to reduce the risk of excessive bruising and bleeding of the vagina.
The tissue between the anal and vaginal openings is called the perineal body, and its job is to help keep the back wall of the vagina supported. This area is also commonly damaged when giving birth, through tears or episiotomies, and often requires repair at the same time.
Rectoceles commonly exist together with prolapse at other sites, such as the uterus or the front wall of the vagina (the cystocele). If there is a prolapse at any other site, repair of this site may be required.
What complications can occur?
The following complications can occur:
Constipation: This is common after surgery and can easily be treated with laxatives and a high-fibre diet, as well as adequate hydration.
Painful intercourse: Some women have problems with sex after any vaginal surgery because the vagina becomes very tight. While every effort is made to prevent this happening, it is sometimes unavoidable.
Damage to surrounding organs: This can include bowel or blood vessels. This is rare but requires repair and this can result in a delay in recovery. Sometimes injury is not detected at the time of surgery and therefore requires a return to the operating theatre. If the rectum is damaged, a temporary colostomy may be required but this is very rare.
Recurrence of prolapse: If you have had one prolapse, there is a risk of having another prolapse sometime in your life. This is due to a weakness in the vaginal tissue and means that the repair could fail or may not work.
What is the recovery following the surgery?
Most women stay in hospital for two nights following posterior repair. Occasionally a longer stay may be required.
Although vaginal surgery does not produce a visible scar, the healing process still takes time. A creamy, brownish discharge, which is sometimes bloody too, is common for up to six weeks, and will gradually disappear as the stitches begin to be absorbed.
There is a risk of constipation for several weeks after surgery, and we can prescribe laxatives. No stitches will be damaged when the bowels do open, which will usually happen about two to three days after surgery.
You should be able to be fit enough for light activities within a month of surgery. However, we recommend avoiding very heavy lifting, heavy household chores, driving and sport for at least six to eight weeks to allow the wounds to heal. Most people need about six to eight weeks off work.
For many women, sex after the operation is improved because there is no longer any discomfort due to prolapse. However, this may be different. We advise that you avoid penetrative intercourse for about six weeks or until after your check-up with your doctor. You are advised to use a vaginal lubricant (such as K-Y jelly) or vaginal moisturiser (such as Sylk or Replens). These are available to buy over the counter at your chemist. Some women may also benefit from vaginal oestrogen therapy.
How successful is the operation?
The success rates for posterior repair are mainly positive, with most women noticing significant improvement in their symptoms. There is a risk of recurrence of the prolapse in 10–20% of women. The prolapse can reoccur at the top of the vagina (vaginal vault prolapse) or in another area such as at the front of the vagina. Factors that increase the chance of recurrence are related to increased pressure on the pelvic floor such as through straining, lifting heavy objects or a high BMI.
Around 50% of women who have symptoms related to bowel movements will also see an improvement in their symptoms.
