How to Ensure Successful Rectocele Surgery (plus Benefits and Risks of Rectocele Repair)

Are you considering having rectocele surgery?

Some women have good outcomes while others have ongoing symptoms that may require further rectocele repair.

The type of rectocele surgery performed may determine the success of surgery. Research now suggests that one popular approach to surgery is more successful than another.

Read on now to learn the types of outcomes women experience after rectocele surgery and learn:

• What is a rectocele?
• Typical rectocele symptoms 
• 2 main types of rectocele surgery
• When to avoid rectocele surgery
• Positive outcomes from posterior vaginal wall surgery
• Potential complications after rectocele repair surgery
• Overall success of the main types of rectocele surgery
• Steps to manage rectocele, avoid prolapse surgery & improve surgical outcomes

What is a Rectocele?

A rectocele is a bulge of the rectum into the back wall of the vagina (shown right). This type of prolapse can protrude and bulge from the vagina when it’s severe.

Rectocele is the most commonly occurring form of posterior vaginal prolapse. The other type is called enterocele and occurs when the small bowel bulges into the vagina.

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Typical Rectocele Symptoms

Typical rectocele symptoms include:¹

• Difficulty emptying the bowel
• Needing to splint the vagina with the fingers to assist bowel movements
• Sexual dysfunction
• Fecal incontinence
• Vaginal bulge

2 Main Types of Rectocele Surgery

Rectocele surgery may be performed a number of ways including through the vagina or anus.

The most commonly used surgical approaches are:

1. Transvaginal  Prolapse Repair

The rectocele is repaired using a long incision or cut through the back wall of the vagina which is accessed through the vagina.

2. Transanal Prolapse Repair 

The rectocele is repaired using 2 incisions made in the front wall of the rectum which is accessed through the anus.

When to Avoid Rectocele Surgery

Rectocele surgery is usually performed on women with moderate to severe posterior vaginal wall prolapse that effects their quality of life. Surgery is usually performed when non surgical rectocele treatment techniques have been unsuccessful.

Non surgical rectocele treatment includes:

• Pelvic floor muscle training
• Lifestyle management (e.g. weight loss, appropriate exercise, bowel management)
• Pessary support

Rectal prolapse surgery is not recommended when the patient: 

• Seeks to have more children ²
• Is too frail for surgery ²
• Has a mild rectal prolapse

Many women manage mild-moderate rectocele prolapse using non surgical methods of treatment.

Benefits of Rectal Prolapse Surgery

A number of positive outcomes have been reported in studies following surgery using either the vaginal or anal approaches to rectal prolapse surgery.

Positive outcomes include:

• Improved bowel emptying with reduced need to manually assist ³
• Better sexual function especially in women after vaginal approach surgery compared with anal approach ⁴
• Improved general quality of life ⁴

Potential Complications After Rectal Prolapse Surgery

A number of complications have been reported in research following rectal prolapse surgery.⁵

These complications include:

• Repeat prolapse occurs approximately 12 years after the first vaginal approach repair
• Adverse events such as infection, urinary retention (difficulty completely emptying the bladder) or pain with intercourse
• 30% of women continue to have the sensation of prolapse coming down after surgery
• More than 80% of women have at least one ongoing prolapse symptom after vaginal approach rectocele surgery

Overall Success of the Major Types of Rectal Surgery

Rectocele surgery seems to be more effective when performed through the vagina compared with through the anus.²

Analysis of quality studies to date suggests repeat rectocele is more likely after anal approach to surgery (compared with the vaginal approach).²

Rectocele surgery does not assure that the patient will be symptom free long-term and repeat prolapse may be a possibility.

Steps to Manage Rectocele, Avoid Prolapse Surgery and Improve Surgical Outcomes

If you’re seeking to avoid prolapse surgery or if you’re having surgery there are a number of positive steps you can take to improve your chances of success.

Make an appointment to see a Pelvic Floor Physiotherapist. Your Physiotherapist can tell you the severity of your prolapse and treat your prolapse according to the factors that may increase your risk of worsening prolapse or repeat prolapse.

Physiotherapy treatment includes:

• Pelvic floor training
• Bowel management and emptying techniques to avoid constipation and straining
• Dietary advice to improve bowel function
• Bladder emptying training
• Appropriate general exercise selection
• Modifying other lifestyle factors contributing to your prolapse issues
• Advice on managing sexual problems with prolapse or after surgery
• Pessary fitting to support your prolapse
• Postoperative recovery management

Further Reading

» 10 Rectocele Repair Rules for Avoiding Repeat Prolapse Surgery

» Stool Softener Foods that Avoid Prolapse Worsening

» Constipation and Prolapse – 10 Expert Tips for Better Bowel Movements

References

1. Cundiff G, Fenner D.(2004) Evaluation and treatment of women with rectocele: focus on associated defecatory and sexual dysfunction. Obstet Gynecol.104(6), pps 1403-21.

2. Mowat A. et.al. (2018) Surgery for women with posterior compartment prolapse Cochrane Database of Systematic Reviews Surgery for women with posterior compartment prolapse(Review). Issue 3.

3. Nieminen K. et al (2004) Transanal or Vaginal Approach to Rectocele Repair: A Prospective, Randomized Pilot Study. Diseases of the Colon & Rectum. 47(10):1636–1642.

4. Fidela M. et al. (2006) Rectocele repair: A randomized trial of three surgical techniques including graft augmentation. American Journal Obstetrics & Gynecology, 195, 6, pps 1762–1771.

5. Glazener M. et al (2017) Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT).The Lancet, 389, 28, pps 381-392.