Rectocele Repair

Rectocele repair is a surgical procedure to correct a bulge in the wall between your rectum and vagina. Your provider may recommend surgical repair if you have symptoms like pain, difficulty pooping or sexual dysfunction. During the repair, your provider will use sutures or a medical device to strengthen the tissue between your rectum and vagina.

Overview Procedure Details Risks / Benefits Recovery and Outlook When To Call the Doctor

Rectocele repair is a surgical procedure to treat bulging from your rectum into your vagina (rectocele). Your rectum is the last part of your intestines. It sits behind your vagina. The bulge happens when the tissue that separates your vagina and rectum gets thin and weak.

When a healthcare provider repairs a rectocele, they fix the bulge and then use sutures (rows of surgical stitches) or a medical device that acts as an anchor to strengthen the wall between your vagina and rectum. A gynecologist, urologist or colorectal surgeon can perform a rectocele repair, depending on the technique and other issues that need to be addressed during the surgery.

Rectocele repair is also sometimes called posterior colporrhaphy.

Healthcare providers usually only recommend surgical repair for rectocele if you have bothersome symptoms — like vaginal bulge, difficulty pooping, pain or sexual dysfunction — and nonsurgical treatments don’t help.

Your provider will give you instructions on how to prepare for the surgery. Following their directions closely can reduce your risk of complications. Before a rectocele repair, your provider may ask you to:

  • Get blood or urine (pee) tests.
  • Not eat anything for six to eight hours before the procedure (fast).
  • Stop taking medications before the procedure or take them with just a sip of water. Don’t stop taking medications unless your provider tells you to.
  • Take stool softeners or complete additional bowel prep leading up to the surgery.
  • Make arrangements for someone to drive you home when you’re released from the hospital (rectocele repair requires you to stay at least one night in the hospital).

During rectocele repair, a healthcare provider will:

  1. Put you under general anesthesia.
  2. Give you antibiotics through an IV.
  3. Make an incision (cut) in the back wall of your vagina. They may do this through your vagina (transvaginal), anus (transanal) or perineum (transperineal).
  4. Insert a catheter to drain pee.
  5. Use sutures or other techniques to anchor your ligaments and strengthen the tissue between your vagina and rectum. (Mesh is usually not recommended anymore.)
  6. Correct any other issue, like perineal thinning or other displaced areas of tissue (prolapse).
  7. Close incisions.

Rectocele repair surgery takes about an hour. It might take longer, depending on your specific circumstances (for example, if your surgeon repairs other issues at the same time).

You’ll recover in the hospital for one to three days after rectocele repair. When you go home, a provider will:

  • Remove your catheter.
  • Prescribe pain medications and give you instructions on how to take them.
  • Give you instructions on how to take care of yourself during recovery.

You’ll need someone to drive you home from the hospital. Your provider might recommend not driving for a few days afterward, too.

The main advantage of rectocele repair is symptom relief. Depending on the approach your surgeon takes (transvaginal, transanal or transperineal), your provider can also repair other issues if you have them.

Like all surgeries, rectocele repair has some risks. These include:

  • Bleeding.
  • Incision site infection.
  • Urinary tract infection (UTI).
  • Painful sex.
  • Fistula (opening) between your vagina and rectum.
  • Symptoms that don’t resolve after surgery or come back later.

It can take three to six weeks to recover from rectocele repair surgery. Your recovery will be unique to you and how you heal. In the first few days after surgery, you’ll probably feel sluggish. As you recover, you’ll gradually return to normal activities. It’s important to push yourself to return to normal activities as you’re able. Listen to your body while increasing your activity level.

Your provider will give you instructions on which activities are safe and which to avoid. Instructions may include:

  • Not having sex.
  • Taking stool softeners or following certain food recommendations to avoid constipation.
  • You may walk and climb stairs right after surgery. Walking and stair climbing won’t hurt your surgical repair.
  • You can return to other activities like lifting, running, high-impact aerobic activities and sit-ups as soon as you feel strong enough.

During your recovery, you might notice discharge from your vagina and have some vaginal bleeding. If you notice a lot of blood or a bad smell, contact your provider right away.

Your body position while you poop can help avoid straining and pain after rectocele surgery. Experts recommend you do the following to position yourself while you poop:

  • Don’t strain. Bowel regimens to keep your stool soft can help.
  • Don’t hover. Put your butt directly on the toilet seat.
  • Don’t let your feet dangle. Make sure they’re flat on the floor — use a stool or something else to rest your feet on if you have to.
  • Lean your chest forward. Make sure your lower back curves naturally inward.
  • Support your upper body. Rest your hands or forearms on your thighs.
  • Raise your knees. Some people find it easier to poop if they plant their feet on a stool or other sturdy object to raise their knees above the height of their hips.

Studies suggest that about 75% to 90% of people have symptom improvement after surgery for rectocele. Sometimes, symptoms can return over time. What kind of symptoms you have, how long you’ve had them and what kind of surgery you had can all play a role in how successful the repair is.

When you go back to work or school depends on how quickly you recover and feel ready to return to work. But for more strenuous jobs, your provider may recommend you take six weeks off.

When should I call my healthcare provider?

Call your healthcare provider if you have any questions about caring for yourself during recovery, or if you experience:

  • Heavy bleeding.
  • Foul-smelling discharge.
  • Severe pain.
  • Fever.
  • American Society of Colon and Rectal Surgeons (ASCRS). Rectocele Expanded Information (https://fascrs.org/patients/diseases-and-conditions/a-z/rectocele-expanded-information). Accessed 3/13/2024.
  • Aubert M, Mege D, Le Huu Nho R, Meurette G, Sielezneff I. Surgical management of the rectocele – An update (https://pubmed.ncbi.nlm.nih.gov/33495108/). J Visc Surg. 2021 Apr;158(2):145-157. Accessed 3/13/2024.
  • Noé GK. Genital Prolapse Surgery: What Options Do We Have in the Age of Mesh Issues? (https://pubmed.ncbi.nlm.nih.gov/33450901/) J Clin Med. 2021 Jan 13;10(2):267. Accessed 3/13/2024.
  • Nüssler E, Granåsen G, Nüssler EK, Bixo M, Löfgren M. Repair of recurrent rectocele with posterior colporrhaphy or non-absorbable polypropylene mesh-patient-reported outcomes at 1-year follow-up (https://pubmed.ncbi.nlm.nih.gov/30627830/). Int Urogynecol J. 2019 Oct;30(10):1679-1687. Accessed 3/13/2024.

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