Posterior Prolapse Repair

This document will give you information about a posterior prolapse repair. If you have any questions, contact your consultant. Prolapse occurs when the pelvic floor muscles (the muscles responsible for keeping your bladder, uterus, vagina and rectum in place and functioning properly) weaken. A weakening of the support tissues between your vagina and bowel results in the bowel bulging through the posterior (back) vaginal wall (see figure 1).

What are the symptoms of a posterior prolapse?

A posterior prolapse can cause a sensation of ‘something coming down’ and the feeling of not having fully emptied your bowel. The condition can also cause discomfort when having sex and make it difficult to keep a tampon in.

What causes a posterior prolapse?

A posterior prolapse is usually caused by childbirth, which has led to the pelvic floor muscles becoming stretched or damaged. However, it is not uncommon for it to happen in women who have never been pregnant too. Prolapses can also become more noticeable after the menopause when the quality of the supporting tissues begin to weaken.

What are the benefits of the procedure?

The aim of the operation is to tighten the support muscles between your vagina and bowel, and remove any bulge in your vagina by moving the bowel back into position. If you have experienced difficulty going to the toilet or discomfort during sex, the procedure should help remedy or improve these problems.

What are the alternatives to this procedure?

As a posterior repair is a major operation, it is usually recommended after simpler, non-surgical treatments have failed. If your prolapse is only mild, your consultant will usually recommend alternatives such as pelvic-floor exercises (to strengthen the pelvic floor muscles) or by treating any constipation. Your consultant may also suggest a pessary, a soft plastic ring inserted into the vagina to push the prolapse back up. This can help get rid of any discomfort and improve urinary and bowel symptoms. However, some couples report that a pessary ring gets in the way during sexual intercourse.

What does the operation involve?

The procedure is can be performed under a spinal anaesthetic, which will numb you from the waist down, or under a general anaesthetic which means you will be unconscious for the duration of the operation. Your consultant will make a cut on the back wall of your vagina over the bulge, in order to push your bowel back. They will then use stitches to tighten the support tissues along the length of the back wall of your vagina and keep the bowel in its normal position. Your consultant will need to cut away a small part of your vaginal wall so they can remove excess tissue. If the muscles on either side of the entrance to your vagina are also weak, your consultant will use stitches to tighten them. The operation usually takes about 30 minutes.

What complications can happen?

As with any operation, there is the potential for risks. General complications include pain, feeling or being sick, bleeding, unsightly scarring, deep vein thrombosis (blood clots) or an infection of the surgical site (wound). Complications specific to the procedure include difficulty opening your bowels, developing a haematoma, or damage to your bowel and surrounding structures. The procedure could also lead to difficulty having sex, or reduced sensations during sex.

How long will it take for me to recover?

You should expect a slight discharge or bleeding from your vagina after the procedure. Let the healthcare team know if this becomes heavy or you show any signs of an infection. You will usually be able to return home after one to three days. You will need to rest for up to two weeks. Staying mobile will reduce the possibility of blood clots. Do not use tampons for six weeks and do not have sex for six weeks or at least until any bleeding or discharge has stopped. Do not stand for too long, lift anything heavy or perform any physical activity that will cause you to strain. Avoid constipation by drinking lots of water/juice, eating fruit and vegetables and plenty of roughage like bran and oat. You will be able to return to work once your consultant has said you are well enough to do so. This is usually after six to eight weeks. Continue your pelvic-floor exercises as soon as possible and keep doing them for life to maintain muscle strength.

References: EIDO Healthcare Limited – The operation and treatment information on this website is produced using information from EIDO Healthcare Ltd and is licensed by Aspen Healthcare.

The information on this document should not replace advice that your relevant health professional would give you.

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