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?Rectocele prolapse

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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International best selling prolapse exercise guide for women with prolapse and after prolapse surgery.

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Prolapse Exercises teaches you how to:

  • Exercise safely after prolapse surgery
  • Reduce your risk or repeat prolapse
  • Avoid unsafe exercises
  • Choose pelvic floor safe exercises
  • Reduce your risk of prolapse worsening
  • Improve prolapse support
  • Increase your strength and fitness
  • Strengthen your core
  • Lose weight

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 SurgeryPregnant woman with child

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.

Walking at beachPhysiotherapy 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


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. (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.

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We Welcome Your Comments


  1. Hi Rose
    Well I ve had surgery all well at the minute nobody said much after only avoid constipation and no after care until February 2021 so not really sure what I am doing

  2. Nicola Biswell says

    Hi everyone
    I am waiting on a rectocele repair but the more I read I ve know became quite scared to go ahead with the operation anybody out there who can give some reassurance would be great .

    • Hi Nicola, i had 4 rectocele repairs and and finally a rectocele prolapse in September 2020 by a urologist who actually listened to me. I had an internal vaginal tear with my first child, which went unnoticed by the doctor till 5 days later. This caused all my problems. No one gave me advice on aftercare except to avoid constipation. I am confident that with Micheles advice this time i will be fine!

  3. katharine says

    I have been carefully reading as much as I can on your prolapse exercises, but all of the references seem to come back to prolapse through the vagina. I have been diagnosed with a rectal prolapse that presents through my anus.. I am worried that none of your advice applies specifically to that. Can you provide some information on whether your prolapse exercises and prolapse dvd is equally applicable? im finding it quite hard to find support and information at the moment and am becoming increasingly distressed and worried.
    many thanks

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Katherine
      Thanks for your enquiry and yes I understand your concern. There’s often confusion about rectocele (prolapse through the vagina) and rectal prolapse (rectum through the anus). The safe exercise principles are exactly the same for both conditions. Here is a little more information on rectal prolapse for you to read. The Prolapse Exercises book describes this issue and it’s a great place to start to manage your pelvic floor friendly exercises. All the exercise DVDs on site are appropriate for your condition too – most women start with the Inside Out Strength DVD. I hope this helps, all the best

  4. Hi Michelle, Any help you can offer would be so appreciated. I am 71 years old and have gone from being a highly active, yogI and exercising woman who had a career as a Broadway actress to being virtually sedentary and depressed due to vaginal pain. I had a rectocele nearly 3 years ago. I went to a urogynecologist in NYC who said I needed a bladder lift along with the other repair. The surgery was completed, I went to a pelvic floor physical therapist, and 4 months later I was still complaining about feeling the bulge from the rectocele. The surgeon said it was just just scar tissue and would go away. I also suffered terribly from neuropathy in my left leg and foot from being in the lithotomy position for the 5 1/2 hour surgery and had to take large quantities of gabapentin. I went to my OBGYN finally who said the rectocele repair had not been done. I found a new urogynecologist and he performed a rectocele repair. When I complained that I still had vaginal discomfort, he said I needed a cystocele repair. He did that surgery. I am now full of scar tissue, and still have vaginal pain that prevents me from exercising and enjoying my life. Walking is limited. Gravity is my enemy. I have to lay down to relieve the discomfort in my vagina. I have been told kegels will not help. I am not an old 71. I am full of energy and want to get back into life. I was dancing on Broadway until I was 60. Please give me any advice or hope that there is something I can do to rectify this situation. Thank you so much. Sally

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Sally I’m so sorry to read your story and your suffering, thank you for taking the step to share. Sally pelvic pain can be assessed and treated by an experienced women’s health physiotherapist. Have you been able to access treatment with an experienced pelvic floor physio? Kegels won’t be the answer at the moment and will likely make the condition worse. Please feel welcome to message me if you require assistance accessing a pelvic floor physio, I may be able to make enquiries to source some assistance in the US on your behalf. All the best to you Sally

  5. Hi I have had a pelvis floor rectocile repair a week ago. I am terrified of it returning. When I look with a mirror I feel I can see it though a lot higher than it was ,as before it was pretruding out. I’m not sure if I’m paranoid as keep looking and getting upset as feel still there. My consultant said she is pleased. I know there are no guarantees but some things I read are frightening like ‘ more than 80precent rectocele will return. I have taken 4weeks off and resting a lot as now 7days in but surely I need to start moving as long as I don’t lift is this true. Please advise ?

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Jenine
      Yes it is important to move after surgery – did you receive instructions from your hospital with your discharge papers? Most women commence walking before discharge and progress daily walking after discharge particularly over the first 6 weeks of their repair. I think many women worry that their prolapse will return after surgery, this is a common fear. Avoid heavy lifting, keep your stool soft and use the correct bowel emptying technique to avoid straining and constipation. Walking will also help your bowel motility unless you’ve been advised otherwise. If you’re really unsure you can phone your doctor’s rooms and ask for information about your doctor’s guidelines for your post op exercise program. All the best for your recovery Jenine

  6. Hi Michelle,
    I just found your articles and resources. I purchased and downloaded one of your ebooks. I have surgery tomorrow morning at 7:30 am for rectocele repair, through the vaginal wall. I love my doctor, she is a uro – gynecologist, and diagnosed my prolapse about 2 1/2 years ago. I saw a pelvic floor Physiotherapist, who was great. I did the exercises, and we discussed a pessary, but my doc didn’t feel it would help the problem much. So I have “managed” this for quite a while. I am 62 and want to get it fixed while I am still fairly fit and healthy otherwise. Your resources are so very helpful. I was able to show several things to myhusband to help him understand what the prolapse is (and isn’t) , and also what I will be going through tomorrow. I feel much more prepared for the “after” effects after reading your information. Your info is an answer to a prayer!

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      I’m so glad to read this Christine – especially that you feel prepared and your husband has an improved understanding, all the best for your surgery and speedy recovery!

  7. Michelle, I appreciate your work so very much! I am back to exercising because of your books, DVDs and guidance. I feel confident that I’m exercising safely after prolapse repair surgery and taking care of my health. THANK YOU!!!!

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Great to hear your news Jill, I’m so glad to read that you’re doing so well – keep it up!

  8. You have made an immense improvement in my life post-prolaps Michelle and I can’t thank you enough. Difficult but could you consider the psychological side to the causes?
    Trapped in a very unhappy marriage, I was constantly constipated. The day I found the courage to leave, my constipation stopped completely. I’m now only troubled on long car journeys.
    Prolapse surgery to remove the sagging brought me in contact with surgeons and specialist all of whom laughed at my observations.
    We call the gut our second mind these days. I believe there is an incidence with prolapse as part of the cause.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Kate
      You know your body better than anyone, go with your hunch on this – there’s absolutely no doubt that the mind affects the gut and our bowel movements. I also feel sure this impacts on women with prolapse issues too, perhaps even more so for women who are already having difficulty with regular emptying caused by their prolapse. It will depend upon the type of prolapse and the extent of the prolapse too along with our mental state, gut health, diet it all plays a part. Would you like to see some information on the psychological aspects related to constipation? So glad to read that things in your life are going so well.