Understanding Posterior Prolapse Repair & Colpoperineorrhaphy: Making Sense of My Surgery and Recovery

Last week I had surgery to reconstruct my pelvic floor. And, being very much me, I went into full research mode.

Before this, I honestly wasn’t very aware that this kind of surgery even existed — and I suspect many other women are the same, unless they’ve supported a loved one through it or experienced pelvic floor issues themselves. I wanted to properly understand what had been done to my body, why it was necessary, and what that meant for my recovery.

One thing that really helped was learning the difference between a posterior colporrhaphy and a colpoperineorrhaphy. Understanding this has helped me make sense of my symptoms, my healing, and why recovery feels the way it does. I’m sharing it here in the hope it helps another woman feel a little less confused and a little more informed.

What is a posterior prolapse repair?

A standard posterior prolapse repair is often called a posterior colporrhaphy.

This surgery focuses on the back wall of the vagina, where the rectum can push or bulge forward. This bulge is known as a rectocele.

The aim of a posterior colporrhaphy is to:

Strengthen and reinforce the vaginal wall
Reduce the bulge created by the rectum
Improve symptoms related to bowel emptying and pressure

For some women, particularly those with milder prolapse or fewer symptoms, this type of repair can be enough.

What is a colpoperineorrhaphy?

A colpoperineorrhaphy is a more extensive repair.

It includes:

A posterior vaginal wall repair
Reconstruction of the perineum, the tissue and muscles between the vagina and anus

The perineum plays a crucial role in pelvic stability, bowel support, and continence. Over time (and often after childbirth, surgery, menopause, or connective tissue issues), this area can become weakened or stretched.

This surgery doesn’t just address the visible bulge; it works on the structural foundation underneath. In other words, it’s not only repairing the wall, but also rebuilding the support system that holds everything in place.

For women with more advanced prolapse, ongoing bowel symptoms, or perineal damage, this deeper reconstruction can be necessary.

Normal anatomy, no prolapse (left), and Posterior wall prolapse (right)
Source:yourpelvicfloor.org

Symptoms: What Might You Notice With a Posterior Prolapse?

Posterior prolapse symptoms can be subtle at first, which is why many women live with them for years before realising what’s going on.

Common symptoms include:

A feeling of pressure, heaviness, or fullness in the vagina
The sensation of something bulging or sitting low
Difficulty emptying the bowels fully
Needing to strain despite soft stools
A feeling of blockage or obstruction when trying to poo
Needing to change position or apply pressure to help bowel emptying
Lower back or pelvic discomfort, especially after standing or walking

Symptoms that worsen as the day goes on

Some women describe it as feeling like things are “falling down” or “out of alignment,” while others simply know that something doesn’t feel right.

Why Understanding the Surgery Matters for Recovery

Knowing whether you’ve had a posterior colporrhaphy or a colpoperineorrhaphy can really help you make sense of recovery.

A more extensive repair often means:

A stronger sense of tightness or pulling during healing
More emphasis on rest, lying down, and pressure reduction
Slower return to normal movement and activity

A longer timeline for tissues to fully settle

Healing isn’t just about the surface stitches. it’s about deep muscles and connective tissue, relearning how to support you again. That takes time, patience, and a lot of kindness toward your body.

Why talking about this matters

Pelvic floor surgery isn’t something we talk about openly enough, yet so many women are quietly living with prolapse symptoms without understanding what’s happening or knowing that help exists.

Learning the language and the differences between procedures has been empowering for me, not because it makes recovery quicker, but because it makes it less frightening and less lonely.

If you’re navigating this yourself, please know: you’re not broken, you haven’t failed, and you’re certainly not alone. Your body has carried you through a lot, and now it’s time to let it heal.

I will share my healing journey with you.

Love & healing hugs

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