Rectocele Repair: Surgery Types, Procedure, Risks and Recovery
Updated: 3 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: November 2026 · How we review
Quick Answer: What is rectocele repair?
Rectocele repair is surgery to fix a bulge of the rectum into the vagina, which happens when the tissue wall between them becomes thin and weak. A surgeon strengthens the wall with stitches, usually through the vagina. Most people recover in three to six weeks, and about 75% to 90% have fewer symptoms afterward. [1]
What the research says
Repair through the vagina holds up better than repair through the anus. A Cochrane review of 10 randomized trials with 1,099 women found that recurrent prolapse on examination was more likely after transanal repair than transvaginal repair (RR 4.12), and awareness of a bulge was also more common (RR 2.78). Adding mesh or graft material to a posterior repair was not supported. (Mowat et al., Cochrane Database of Systematic Reviews, 2018) [2]
Most posterior repairs improve both the bulge and bowel symptoms. A systematic review of 46 studies found that native-tissue transvaginal rectocele repair improved prolapse and obstructed-defecation symptoms, with greater anatomical improvement and less risk of rectal injury than the transanal route, but higher rates of painful sex. The authors recommend native-tissue transvaginal repair as the preferred approach. (Grimes et al., International Urogynecology Journal, 2019) [3]
Transvaginal repair eased constipation more than transperineal repair. In a randomized trial of 64 women with rectocele and obstructed defecation, both approaches lowered constipation scores at 6 and 12 months, but the drop was larger after transvaginal repair, which also brought a slightly shorter hospital stay (2.1 vs 2.4 days) and better sexual quality of life. (Balata et al., Diseases of the Colon & Rectum, 2020) [4]
Key takeaways
Rectocele repair fixes a bulge of the rectum into the back wall of the vagina. [1]
Surgery is usually advised only when symptoms are bothersome and nonsurgical treatment has not helped. [1]
The operation takes about an hour, and most people stay in the hospital one to three days. [1]
Recovery takes about three to six weeks; symptoms improve for about 75% to 90% of people. [1]
Mesh is usually no longer recommended for this repair. [1]
What is rectocele repair?
A rectocele forms when the thin wall of tissue between the rectum and the vagina weakens, letting the rectum bulge into the vagina. Rectocele repair is surgery that strengthens that wall and returns the rectum to its normal position. It is also called posterior colporrhaphy. [1]
A gynecologist, urologist or colorectal surgeon may do the operation. A rectocele is one type of pelvic organ prolapse; to learn about the other types, see our guide to pelvic organ prolapse. [1]
When is rectocele repair needed?
Surgery is usually recommended only when symptoms bother you and nonsurgical treatments have not helped. Symptoms that may lead to repair include: [1]
Can a rectocele be treated without surgery?
Yes. Surgery is not always necessary. Symptoms can often be managed by avoiding constipation with a high-fiber diet of more than 25 grams a day and plenty of water, not straining on the toilet, doing Kegel exercises or using a pessary, a removable device placed in the vagina for support. [1]
What are the types of rectocele repair?
Surgeons can reach the weakened wall in three ways: [1]
Approach | How the surgeon reaches the rectocele |
Transvaginal | Through an incision in the back wall of the vagina |
Transanal | Through the anus, from inside the rectum |
Transperineal | Through the perineum, the skin between the vagina and the anus |
Sources: [1]
How do you prepare for rectocele repair?
Your care team will give you specific instructions. Common steps include: [1]
What happens during rectocele repair?
You receive general anesthesia, so you are fully asleep, and antibiotics through an IV. [1]
The surgeon makes an incision, most often in the back wall of the vagina. [1]
The surgeon anchors the supporting ligaments and strengthens the tissue wall with stitches or other techniques. [1]
Other problems found at the same time, such as a thin perineum or another prolapse, may be repaired too. [1]
The surgery takes about an hour, or longer if other repairs are done at the same time. Mesh is usually no longer recommended. [1]
Key numbers for a planned rectocele repair.
Rectocele repair at a glance
Item | Typical detail |
Anesthesia | General (you are asleep) |
Operating time | About 1 hour |
Hospital stay | 1 to 3 days (at least one night) |
Recovery | About 3 to 6 weeks |
Time off strenuous work | About 6 weeks |
Symptom improvement | About 75% to 90% of people |
Sources: [1]
What happens after rectocele repair?
Most people stay in the hospital one to three days. Before you go home, your urinary catheter is removed, you get pain medicine and you receive home-care instructions. You will need someone to drive you home, and you may be told not to drive for a few days. [1]
What is recovery from rectocele repair like?
Recovery takes about three to six weeks. It is common to feel sluggish for the first few days, then slowly return to normal activity. [1]
Walking and climbing stairs are generally fine right after surgery. [1]
You may be asked to avoid sex for a while and to use stool softeners. [1]
Lifting, running, high-impact aerobics and sit-ups can restart once you feel strong enough. [1]
Some vaginal discharge and bleeding is normal. [1]
Return to work depends on your job; physically demanding work may need about six weeks off. [1]
How should you have bowel movements after rectocele repair?
Protecting the repair while it heals means avoiding pressure on it. [1]
Simple toilet habits help protect the repair.
What are the benefits and risks of rectocele repair?
The main benefit is relief of symptoms such as the vaginal bulge and trouble with bowel movements, and other pelvic floor problems may be fixed in the same operation. Studies suggest about 75% to 90% of people have fewer symptoms, although symptoms can come back. [1]
Risk | What it means |
Bleeding | Blood loss during or after surgery |
Infection | Infection at the incision or a urinary tract infection |
Painful sex | Discomfort during intercourse after healing |
Fistula | An abnormal opening between the vagina and the rectum |
Ongoing or returning symptoms | Symptoms that do not go away or come back later |
Sources: [1]
When should you call your doctor after rectocele repair?
Call your provider if you have any of these: [1]
Conclusion
Rectocele repair strengthens the weak wall between the rectum and the vagina when a bulge causes bothersome symptoms that other treatments have not fixed. It usually takes about an hour, needs a one- to three-day hospital stay and three to six weeks of recovery, and improves symptoms for most people. [1]
If a rectocele is affecting your daily life, ask your gynecologist, urologist or colorectal surgeon whether nonsurgical options or a repair are right for you.
Keep learning: Read our guides to pelvic organ prolapse, constipation and rectal prolapse. For more on prolapse, see the U.S. Office on Women's Health page on pelvic organ prolapse.
FAQ
What is rectocele repair?
It is surgery to fix a bulge of the rectum into the vagina by strengthening the weak tissue wall between them. It is also called posterior colporrhaphy.
When do you need rectocele repair?
Surgery is usually advised when symptoms such as a vaginal bulge, trouble with bowel movements, pain or sexual problems are bothersome and other treatments have not helped.
Can a rectocele be fixed without surgery?
Symptoms can often be managed with a high-fiber diet, plenty of water, not straining, Kegel exercises or a pessary.
How is rectocele repair done?
Under general anesthesia, the surgeon reaches the weak wall through the vagina, the anus or the perineum and strengthens it with stitches.
How long does rectocele repair surgery take?
It takes about an hour, or longer if other repairs are done at the same time.
How long is the hospital stay after rectocele repair?
Most people stay one to three days and at least one night.
How long is recovery after rectocele repair?
Recovery usually takes three to six weeks, and physically demanding jobs may need about six weeks off.
Is mesh used in rectocele repair?
Mesh is usually no longer recommended for rectocele repair.
What are the risks of rectocele repair?
Risks include bleeding, infection, urinary tract infection, painful sex, a fistula between the vagina and rectum, and symptoms that return.
How successful is rectocele repair?
About 75% to 90% of people have fewer symptoms after surgery, although symptoms can sometimes come back.
How do I prepare for rectocele repair?
Common steps include blood or urine tests, not eating or drinking for 6 to 8 hours before surgery, changes to some of your medicines, stool softeners or a bowel prep, and arranging a ride home, since you'll stay at least one night in the hospital [1].
Does rectocele repair hurt, and what anesthesia is used?
You receive general anesthesia, so you're fully asleep, along with antibiotics through an IV [1]. Before you go home you get pain medicine, and it's common to feel sluggish for the first few days [1].
When should I call my doctor after rectocele repair?
Call your provider for heavy bleeding, discharge with a foul smell, severe pain or fever [1].
Related Reading
Learn more in our guide to Pelvic Organ Prolapse: What It Is, the 4 Types, and How It’s Treated.
Learn more in our guide to Constipation: Symptoms, Causes, Diagnosis and Treatment — What You Need to Know.
Learn more in our guide to What Is Rectal Prolapse? A Plain-Language Guide to the Condition, Its Signs, and Its Treatment.
References
Cleveland Clinic. Rectocele Repair: Purpose, Procedure, Risks & Recovery. Cleveland Clinic. Last updated March 13, 2024. https://my.clevelandclinic.org/health/procedures/16610-rectocele-repair
Mowat A, Maher D, Baessler K, et al. Surgery for women with posterior compartment prolapse. Cochrane Database Syst Rev. 2018;3(3):CD012975. PMID 29502352. https://doi.org/10.1002/14651858.CD012975
Grimes CL, Schimpf MO, Wieslander CK, et al. Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations. Int Urogynecol J. 2019;30(9):1433-1454. PMID 31256222. https://doi.org/10.1007/s00192-019-04001-z
Balata M, Elgendy H, Emile SH, et al. Functional Outcome and Sexual-Related Quality of Life After Transperineal Versus Transvaginal Repair of Anterior Rectocele: A Randomized Clinical Trial. Dis Colon Rectum. 2020;63(4):527-537. PMID 31996580. https://doi.org/10.1097/DCR.0000000000001595
Medical disclaimer
This article is for general education only and does not replace advice from a qualified healthcare professional. Talk to your doctor about your own diagnosis and treatment, and seek emergency care right away for severe or sudden symptoms.
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