What is posterior repair surgery?
Posterior repair surgery aims to tighten the support tissues between your vagina and bowel, and remove any bulge in your vagina.
What is a prosterior prolapse?
A posterior prolapse is a bulge in the back wall of the vagina. It is caused by weakness of the support tissues between the vagina and the bowel (see figure 1).
A posterior prolapse can cause a sensation of 'something coming down', the feeling of not having fully emptied your bowel and the need to press on the back wall of your vagina to fully empty your bowel. It can also cause discomfort when having sex and difficulty keeping a tampon in.
A posterior prolapse is usually caused by childbirth. However, sometimes the problem can happen in women who have never been pregnant.
Usually you only notice the problem after the menopause.
What are the benefits of a posterior repair?
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 only have a mild prolapse, your doctor will usually recommend that you have a posterior repair only after you have tried simple treatments such as pelvic-floor exercises or treating any constipation.
There is another surgical procedure that involves replacing the support tissues with a mesh.
What does the operation involve?
A posterior repair is usually performed under a general anaesthetic. The operation usually takes about half an hour.
Your gynaecologist will make a cut in the back (posterior) wall of your vagina so they can push your bowel back into place. They will then use stitches to tighten the support tissues along the length of the back wall of your vagina. Your gynaecologist will need to cut away a small part of the vaginal wall so they can remove excess tissue.
If the muscles on either side of the entrance to your vagina are weak, your gynaecologist will use stitches to tighten them (perineal repair).
What complications can happen?
General complications of any operation:
- Sickness or feeling sick
- Unsightly scarring
- Blood clots
- Infection of the surgical site (wound)
Specific complications of this operation:
- Difficulty opening your bowels
- Developing a haematoma
- Damage to the bowel and surrounding structures
- Difficulty having sex
How soon will I recover?
You should expect a slight discharge or bleeding from your vagina but you should let a member of the healthcare team know if this becomes heavy.
You will usually be able to go home after one to three days. For the first two weeks at home you should rest, relax and continue to do the exercises that you were shown in hospital.
It is best not to have sex for about six weeks, or at least until any bleeding or discharge has stopped.
Avoid standing for too long and do not lift anything heavy. You can go back to work once your doctor has said you are well enough to do so (usually after six to eight weeks).
Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, you should ask a member of the healthcare team or your GP for advice.
You should continue your pelvic-floor exercises as soon as possible after the operation and keep doing them for life. You should continue to eat plenty of fibre and drink plenty of fluid to keep your bowel movements soft. This will help to prevent the prolapse coming back and reduce the risk of you becoming constipated.
A posterior repair is a major operation usually recommended after simpler treatments have failed. If the operation is successful, your bowel will be better supported and you will no longer have a bulge in your vagina.
Paying for your procedure
Posterior repair costs are covered by most medical insurance policies, but please check with your insurer first. If you are paying for your own procedure the cost will be explained and confirmed in writing when you book the procedure. Ask the hospital for a quote beforehand, and ensure that this includes the surgeon’s fee, the anaesthetist’s fee and the hospital charge for your procedure.
Author: Mr Jeremy Hawe MBChB MRCOG
Illustrations: Medical Illustration
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