June 17, 2022 Author : Leonor Santos One in 10 women who have had children will need surgery to correct a vaginal prolapse . Prolapse of the posterior vaginal wall, or rectocele , is usually due to weakening of the tissues (fascia) that separate the vagina from the rectum. The prolapse may extend beyond the vaginal introitus and may cause difficulty in evacuating , in addition to a feeling of heaviness or a bulge in the vagina . When the posterior vaginal wall is corrected, it is often necessary to correct the perineal body as well. The perineal body is the tissue that separates the anus from the outermost part of the vagina. During childbirth, there are perineum lesions, especially when it is necessary to cut the vagina to allow the baby head to come out. Correction of the posterior vaginal wall is also known as posterior colporrhaphy and consists of strengthening the supporting tissues between the vagina and rectum. Perineoplasty is the designation of the surgical procedure to reinforce the perineal body. Correction of the posterior vaginal wall and perineal body makes it possible to regain adequate support and reduce vaginal entry. Thus: Relieves symptoms of heaviness in the vagina; Improves bowel function (facilitates bowel emptying) and sexual function. How is the posterior vaginal wall repair performed? This surgery can be performed under general or locoregional anesthesia . A cut is made in the back wall of the vagina from the entrance to the bottom of the vagina. The innermost tissue layer of the vagina (mucosa) is separated from the underlying supporting tissue (fascia). Stitches are applied to reapproximate the edges of the fascia. The material of the threads is resorbable, so it is not necessary to remove it, they will be resorbed over 4-6 weeks. The perineal body can be repaired with deeper stitches in the muscles that attach to it. The posterior vaginal wall can also be reinforced with synthetic or biological meshes , which is more common when the surgery needs to be repeated or when the prolapse is large. At the end of the surgery, a compression tampon is placed in the vagina to prevent bleeding and the urinary catheter is maintained. Both are removed, as a rule, the day after the surgery. Surgery success rate Correction of the posterior vaginal wall has a high success rate of 80%-90% . About 50% of women with symptoms of incomplete bowel emptying (feeling like they still have stools after having a bowel movement) or constipation improve after surgery. Risks and complications of posterior vaginal wall repair All surgical interventions have potential risks or complications , both associated with the surgery itself and with anesthesia. The risks and complications of posterior vaginal wall repair are: Severe bleeding, 1% requiring transfusion; Pelvic and vaginal infections are rare; Bladder infection (cystitis) 6%. Cystitis causes burning when urinating, increased urination, sometimes blood in the urine. Whenever necessary, it is treated with antibiotics; Constipation. To avoid it, a diet rich in fiber and increased fluid intake should be followed. The use of laxatives must be done by medical indication; Pain during sexual intercourse (dyspareunia); Rectal injury; Complications associated with networks being used, eg exposure, infection, withdrawal, pain, sexual dysfunction. Postoperative recovery and return to normal life After a correction of the posterior vaginal wall it is normal to have a vaginal discharge for 4-6 weeks after the surgery , which is related to the stitches in the vagina. This discharge decreases as stitches are reabsorbed. If this vaginal discharge has an unpleasant odor, medical attention should be sought. There may still be a slight bloody discharge right after surgery and/or it may appear brownish in color about a week after surgery. Postoperatively, it is important to avoid : Carrying weights; Do physical exercise; Having sex within 6 weeks of the surgery date. Good intestinal functioning should be promoted with a diet rich in fiber and increasing fluid intake . Depending on the professional activity, the period of leave after a correction of the posterior vaginal wall varies between 2 and 6 weeks. In general, healing is complete by 3 months after surgery. Sources International Urogynecologial Association. Posterior vaginal wall and perineal body repair . Meet the obstetrics-gynecology clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
