Rectocele Repair

What is rectocele repair?

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.

Why do you need to repair a rectocele?

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.

How do I prepare for rectocele repair?

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).

What happens during rectocele repair?

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.

How long does rectocele repair take?

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).

What happens after rectocele repair?

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.

What are the advantages of rectocele repair?

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.

What are the risks of rectocele repair?

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.

How long does it take to recover from a rectocele repair?

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.

How do you poop after rectocele surgery?

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.

How successful is rectocele repair?

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 can I go back to work or school?

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.

What happens if you don’t fix a rectocele?

You don’t necessarily need to fix a rectocele unless your provider recommends it. Many people can manage symptoms of a rectocele without surgery. Ways to reduce your symptoms include:

• Avoiding constipation by following a high-fiber diet (more than 25 grams of fiber per day) and drinking plenty of water each day. Talk to your provider about using stool softeners or other medications if you need to.
• Avoiding straining during bowel movements and long periods of sitting on the toilet.
• Strengthening your pelvic floor muscles with Kegel exercises.
• Using a pessary, a device placed into your vagina to reduce the bulge.