What is a posterior prolapse?

A posterior prolapse is a bulge in the back wall of your vagina. It is caused by weakness of the support tissues between your vagina and your bowel.

What are the benefits of surgery?

The aim of surgery is to tighten the support tissues between your vagina and bowel, and remove any bulge in your vagina.

Are there any alternatives to a posterior repair?

If you have a mild prolapse, your doctor will usually only recommend that you have a posterior repair after you have tried simple treatments. These include the following:

• Pelvic-floor exercises — This is the most effective non-surgical treatment.
• Treating any constipation — Drinking plenty of fluid and increasing the amount of fibre in your diet usually improves the way your bowels work.
• Vaginal estrogen cream — This helps lubricate and strengthen the vagina.
• Placing a pessary — This involves placing a device inside your vagina to support the tissues. This can avoid the need for surgery or test which symptoms may be helped by surgery.

Alternatively, you can choose to have no treatment and monitor your symptoms.

If the prolapse is large and you do not plan on having sex again, an option is to close your vagina.

What will happen if I decide not to have the operation or the operation is delayed?

A prolapse can seriously affect your quality of life but is not life-threatening. A prolapse may slowly get larger, eventually appearing at the entrance of your vagina.

If you have only a mild prolapse, your doctor may be able to recommend an alternative treatment for you.

If you experience any of the following symptoms, contact your healthcare team.

• Unusual bleeding.
• The prolapse becoming more prominent.
• A change in your bladder or bowel control.

What does the operation involve?

The operation is usually performed under a general anaesthetic but various anaesthetic techniques are possible. The operation usually takes about 30 minutes.

Your doctor will examine your vagina. They will make a cut on the back (posterior) wall of your vagina so they can push your bowel back into place.They will 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.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team are trained to reduce the risk of complications.

Possible complications of this procedure are shown below. Some can be serious and may even cause death.

Any risk rates given are taken from studies of people who have had this procedure. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, you are obese, you smoke or you have other health problems. Health problems include diabetes, heart disease or lung disease.

General complications of any operation

• Feeling or being sick.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Bleeding during or after the procedure. Usually there is little bleeding.
• Venous thromboembolism (VTE) — this is a blood clot in your leg (deep-vein thrombosis - DVT) or one that has moved to your lung (pulmonary embolus).
• Chest infection — your risk is lower if you have stopped smoking and you are free of Covid-19 symptoms for at least 7 weeks before the procedure.

Specific complications of this operation

• Damage to your bowel and surrounding structures. Your doctor will usually notice any damage and repair it during the procedure. However, damage may not be obvious and this can cause an abnormal connection to develop between your bowel and vagina, causing you to leak poo (faeces).
• Difficulty doing a poo, if your bowel and back wall of your vagina are swollen or bruised.
• Developing a collection of blood (haematoma) between your vagina and your bowel.
• Difficulty having sex. Sometimes the problem can continue for a long time.
• Recurrent prolapse. This is when the same prolapse happens again. You will need another procedure.
• New prolapse. This is when another prolapse happens in a different part of your vagina. You will need another procedure.
• Heavy bleeding which requires a blood transfusion or another procedure.

Consequences of this procedure

• Pain.
• Scarring of the skin at the entrance to your vagina.

How soon will I recover?

You should be able to go home the same day. However, if you have a drip, pack or catheter in place, you may need to stay overnight.

Rest for 2 weeks and continue to do the exercises that you were shown in hospital.

Do not have sex, use tampons, or go in the bath, swimming pool or hot tub for at least 6 weeks and not until heavy bleeding and discharge have stopped.

Do not stand for too long or lift anything heavy. You can return to work once your doctor has said you are well enough to do so (usually after 6 to 8 weeks). You should be feeling more or less back to normal after 3 months.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Continue your pelvic-floor exercises as soon as possible and keep doing them for life.

Summary

A posterior repair is an operation usually recommended after simpler treatments have failed. Your bowel should be better supported and you should no longer have a bulge in your vagina.

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