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Posterior Colporrhaphy (With or Without Perineorrhaphy)

  • Jason P. GilleranEmail author
  • Natalie Gaines
Chapter

Abstract

Evaluation and management of posterior prolapse can be challenging, as patients with rectocele can present with a variety of non-specific complaints, including vaginal bulge, bowel symptoms such as constipation or bloating, need to splint, perineal ballooning, or pelvic pressure. Unlike the anterior compartment, symptoms do not correlate with anatomy, and thus thorough history and physical exam are critical. Pre-operative radiographic evaluation has a limited role and typically does not change management.

Indications for treatment vary, but evidence consistently recommends only treating patients with defecatory symptoms or symptoms of vaginal bulge, regardless of size of rectocele. Management is geared to improve the patient’s symptoms; asymptomatic patients can typically be monitored. Patients with minimal anatomic defect but significant defecatory symptoms may benefit from biofeedback without surgical repair. For symptomatic rectocele, traditional posterior colporrhaphy (PC) is the preferred method of management. It has excellent, durable anatomic and subjective outcomes. When compared to non-native tissue repairs, PC is associated with equivalent quality of life improvement and decreased complication rates.

Keywords

Rectocele Pelvic prolapse Defecatory dysfunction Colporrhaphy 

Supplementary material

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Video 13.2

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of UrologyOakland University William Beaumont School of MedicineRoyal OakUSA

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