A rectocele or bulge of the back wall of the vagina is most often repaired by a vaginal procedure called a posterior colporrhaphy. If the muscles at the opening of the vagina have been stretched or separated during childbirth, the repair may include a perineorrhaphy. A rectocele may also be fixed abdominally at the time of a sacralcolpopexy.
Posterior colporrhaphy is a procedure that repairs the rectal bulge protruding through the back wall of the vagina. During the colporrhaphy procedure, an incision is made in the back wall of the vagina. The vaginal skin is separated from the rectal wall underneath. The weak or frayed edges of the deep vaginal wall tissue are identified. The strong tissue next to these edges are sutured to each other recreating the strong wall between the rectum and the vagina. The vaginal incision is then closed. Sometimes, the levator or pelvic floor muscles are brought together over this weak area to create a thick wall between the vagina and rectum, thus getting rid of the rectocele. This is called a levatorplasty. At times, a surgeon may chose to place a patch or graft material over the repair line to reinforce the repair. Studies are ongoing to help understand the role of these graft materials in rectocele repair. Your surgeon will most likely close the incision with self-dissolving stitches.
Most insurance companies will cover this type of repair and our staff will help obtain authorization and schedule the surgery in a hospital for you. Many times this surgery is done in conjunction with other pelvic reconstructive surgeries or even cosmetic surgeries. Most patients will stay overnight in the hospital but some can leave the same day if they are doing well and ready to go home. Decreased activities for the first two weeks postop are recommended. No heavy lifting or straining activities are recommended for a full three months after surgery. Postoperatively, most patients not only recognize an absence of a vaginal bulge, but also an improvement in their bowel movements and overall quality of life.
Click here to see Before and After pictures for this procedure.