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This document will give you information about a posterior repair. If you have any questions, ask your consultant.
A posterior prolapse is a bulge in the back wall of your vagina. It is cause by a weakening of the support tissues between your vagina and your bowel, and the rectum bulging through the vaginal wall (see figure 1).
A posterior prolapse can cause a dragging or aching sensation. It may also cause difficulties when emptying the bowels. Some women may need to press on the back wall of their vagina in order to fully empty their bowel. The condition can also cause discomfort when having sex and lead to difficulty keeping a tampon in.
A posterior prolapse is usually caused by childbirth where the pelvic floor muscles have been stretched or damaged. However, sometimes the problem can happen in women who have never been pregnant. The condition can also become more noticeable after the menopause when the supporting tissues in the vagina weaken.
The aim of the procedure is to tighten the support tissues between your vagina and bowel, and remove any bulge in your vagina. If you have experienced difficulty going to the toilet or discomfort during sex, the procedure should help rectify these problems.
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 doctor will usually recommend alternatives such as pelvic-floor exercises (to strengthen the pelvic floor muscles) or by treating any constipation. Your doctor 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. There is another surgical procedure that involves replacing the support tissues with a mesh to reinforce the back wall of the vagina.
The procedure is usually performed under a spinal anaesthetic, where you will be numb from the waist down, or a general anaesthetic which means you will be asleep during the procedure. Your doctor will make a cut on the back (posterior) wall of your vagina over the bulge, in order to push your bowel back into its normal place. They will then use stitches to tighten the support tissues along the length of the back wall of your vagina. Your doctor 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 weak, your consultant will use stitches to tighten them (perineal repair, also called a perinorrhaphy).The operation usually takes about 30 minutes.
Any risks or complications will be discussed in advance of your treatment with your expert consultant.
You should expect a slight discharge or bleeding from your vagina after the procedure. Let the healthcare team know if this becomes heavy. You will usually be able to return home after one to three days. You will need to rest for up to two weeks and continue to do the exercises that you were shown in hospital. Do not use tampons for six weeks. Do not have sex for six weeks or at least until any bleeding or discharge has stopped. You may wish to wait until after the stitches have dissolved to prevent any discomfort, which is typically three months. Do not stand for too long, lift anything heavy or perform any physical activity that will cause you to strain. You can return to work once your doctor has said you are well enough to do so (usually after six to eight weeks). Continue your pelvic-floor exercises as soon as possible and keep doing them for life. Drink plenty of fluid and increase the amount of fibre in your diet to keep your bowel movements soft. This will help to prevent the prolapse from coming back and reduce the risk of you becoming constipated.
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 page should not replace advice that your relevant health professional would give you.