Posterior colporrhaphy is a vaginal surgery that repairs the back (posterior) wall of the vagina and the pelvic floor muscle behind it, using the patient's own tissue. It is the standard operation for a rectocele and the structural basis of most surgical vaginal tightening. Done well, it restores support for the bowel, thickens a thinned vaginal wall and narrows a canal that has widened after childbirth or aging, without mesh or implants.
What does "posterior colporrhaphy" mean?
The name describes the operation. "Colpo" means vagina, "rrhaphy" means suturing or repair, and "posterior" refers to the back wall, the side that faces the rectum. In plain English, it is a repair of the back vaginal wall.
The same procedure appears under several names. Gynecologists may call it a posterior repair, posterior vaginal wall repair or rectocele repair. When it is combined with reconstruction of the perineum (the tissue between the vaginal opening and the anus), it is called colpoperineorrhaphy or colpoperineoplasty. In cosmetic settings, the same operation is often marketed as "vaginoplasty" or "vaginal tightening."
What problem does it fix?
The vagina is held in place by layers of connective tissue (fascia) and the levator ani muscles of the pelvic floor. Vaginal childbirth, repeated straining, chronic coughing, heavy lifting, weight gain and the loss of estrogen after menopause can stretch or separate these layers. When the support behind the back wall weakens, several things can happen:
- Rectocele: the rectum bulges forward into the vagina, which can make it hard to empty the bowel completely.
- Vaginal laxity: the canal becomes wider and the walls thinner, which many women notice as reduced sensation or a feeling of looseness during intercourse.
- Air entering the vagina during movement or intercourse, with an audible release afterward.
- A widened or scarred perineum after tears or episiotomy, leaving the vaginal opening gaping.
Posterior colporrhaphy addresses the structure behind all of these symptoms rather than only the appearance of the opening.
Symptoms that suggest the back wall needs repair
- Pressing on the vaginal wall or the perineum to complete a bowel movement (splinting)
- A feeling of incomplete emptying or stool trapped low in the rectum
- A soft bulge felt at the vaginal opening, especially when straining
- Looseness, reduced friction or reduced sensation since childbirth
- Vaginal wind during exercise or intercourse
- A heavy or dragging feeling at the end of the day
None of these symptoms alone proves that surgery is needed. A pelvic examination, often with a standardized prolapse measurement called the POP-Q, shows which wall is affected and how far it has descended.
How the operation is done, step by step
Techniques vary between surgeons, but a native-tissue posterior repair generally follows this sequence:
- Assessment under anesthesia. The surgeon confirms the length and width of the vagina, the thickness of the back wall and whether the uterus or vaginal apex has also descended.
- Opening the back wall. A midline incision is made in the vaginal lining (mucosa), and the lining is carefully separated from the weakened fascia and rectum beneath it.
- Rebuilding the support layer. The separated fascia and the edges of the levator ani muscles are brought together in the midline with absorbable sutures. This layer, not the skin, is what holds the rectum back and gives the canal its new width.
- Trimming and closing the lining. Excess lining is trimmed conservatively and the mucosa is closed over the repair. Removing too much lining is a common cause of pain and narrowing, so experienced surgeons remove as little as possible.
- Perineal reconstruction (if needed). The perineal body is rebuilt to restore the shape and support of the vaginal opening.
Some surgeons begin the repair high in the vagina, near the cervix, and work outward along the full length of the canal. This matters because laxity and prolapse usually start deep inside, so a repair limited to the entrance can leave a tight opening with a loose interior.
Own tissue versus mesh
Posterior colporrhaphy is a native-tissue repair: it uses the patient's own fascia and muscle and needs no permanent foreign material. Synthetic mesh was once used to reinforce vaginal prolapse repairs, but in 2019 the U.S. Food and Drug Administration ordered manufacturers to stop selling transvaginal mesh for prolapse repair because of complications such as erosion, pain and infection, and several other countries have restricted it. For the posterior wall in particular, guidance from the American College of Obstetricians and Gynecologists notes that adding mesh or graft has not been shown to improve outcomes over native-tissue repair.
Anesthesia, length of surgery and hospital stay
The operation typically takes about one hour. It can be performed under general anesthesia, regional (spinal) anesthesia, or intravenous sedation combined with long-acting local anesthetic. When sedation and local anesthesia are used and no other major procedure is combined, many patients go home the same day once they can pass urine comfortably. Sutures are usually absorbable, so there is nothing to remove.
Recovery timeline
- Day 1–3: mild to moderate soreness, swelling and light spotting; walking is encouraged
- Day 2–7: return to desk work and light daily activity; stool softeners help avoid straining
- Week 2–4: swelling settles; light exercise such as walking increases
- Week 6: heavy lifting, running, cycling, swimming and bathing usually resume after review
- Week 6–8: sexual intercourse usually resumes once healing is confirmed
Protecting the repair during healing matters more than any single instruction: avoid constipation, heavy lifting and repeated straining for the first six weeks.
Benefits and realistic expectations
- Bowel symptoms: splinting and incomplete emptying caused by a rectocele often improve once the back wall is supported.
- Bulge and pressure: the visible or palpable bulge is corrected.
- Sexual function: many women report improved sensation and satisfaction once the canal and pelvic floor are restored, although results vary and depend on the cause of the symptoms.
- Durability: because the repair uses living tissue that heals together, results can last for many years. Further vaginal births, chronic straining and aging can stretch the repair again.
Risks to discuss with your surgeon
- Bleeding, infection and reactions to anesthesia
- Pain during intercourse (dyspareunia), most often from over-narrowing or excess tissue removal
- Recurrence of the bulge or looseness over time
- Rarely, injury to the rectum during dissection
- Temporary difficulty passing urine or constipation in the first days
Ask a prospective surgeon how they measure the vagina before and after surgery, how much tissue they typically remove, and what their approach is if intercourse becomes painful afterward.
Who is a good candidate?
Good candidates have symptoms that come from the back wall, are in good general health, have realistic expectations and have finished or paused childbearing, since a later vaginal birth can stretch the repair. Women with mild laxity and a pelvic floor that still contracts well may first try supervised pelvic floor muscle training. Women whose uterus or vaginal apex has also descended usually need that support restored at the same time, because repairing the back wall alone will not hold if the top of the vagina is falling.
How to prepare for posterior colporrhaphy
- Treat constipation in advance so that stools are soft before and after surgery
- Stop smoking, which slows healing and causes coughing that strains the repair
- Review blood thinners and supplements with your doctor
- Arrange help with lifting, shopping and childcare for the first weeks
How it compares with non-surgical options
Pelvic floor muscle training suits mild laxity, a pessary can control prolapse symptoms without surgery, and laser or radiofrequency mainly affects the surface lining. None of these rebuilds separated fascia or a torn perineum, so surgery is usually reserved for structural damage confirmed on examination.
Frequently asked questions
Is posterior colporrhaphy the same as vaginoplasty?
In cosmetic gynecology, the word "vaginoplasty" is commonly used for a posterior colporrhaphy combined with perineal repair. In other fields, vaginoplasty can mean creating a vagina, so it is worth asking any clinic exactly which structures will be repaired.
Does posterior colporrhaphy affect the bladder or urethra?
No. The operation is confined to the back wall. Bladder prolapse (cystocele) and stress urinary incontinence involve the front wall and are treated separately if needed.
Is the surgery painful?
Most women describe soreness rather than sharp pain, controlled with oral pain relief for several days. Long-acting local anesthetic placed during surgery reduces pain in the first hours.
Can I have children after the repair?
Pregnancy is possible, but a vaginal delivery can stretch the repair. Many surgeons recommend waiting until childbearing is complete or discussing a cesarean delivery afterward.
Will there be visible scars?
The incision is inside the vagina and is not visible externally. If the perineum is reconstructed, a fine line may remain at the entrance, which usually fades over several months.
How long do the results last?
Results often last many years because the repair heals as living tissue. Later vaginal births, chronic straining and menopause can stretch it again.
References
- American College of Obstetricians and Gynecologists and American Urogynecologic Society. Pelvic Organ Prolapse, Practice Bulletin No. 214 (2019).
- U.S. Food and Drug Administration. Urogynecologic Surgical Mesh Implants: FDA orders manufacturers to stop selling transvaginal mesh for pelvic organ prolapse repair (April 2019).
- Persu C, et al. Pelvic Organ Prolapse Quantification System (POP-Q): a new era in pelvic prolapse staging. Journal of Medicine and Life (2011).
This article is for general education and does not replace an examination by a qualified gynecologist. Individual results vary, and every procedure carries risks.
