Anterior and posterior vaginal repair

Summary

An anterior or posterior repair is an operation to correct a prolapse of the vaginal wall — the sensation of something bulging or coming down, caused by the bladder pressing into the front wall of the vagina (anterior) or the bowel into the back wall (posterior). The weakened supporting tissue is tightened with dissolvable stitches. Everything is done through the vagina, so there is no abdominal cut.

• Either wall can be repaired alone, or both in the same operation, depending on your examination.
• Usually done under spinal anaesthesia, with the operation taking around 30–60 minutes whether one or both walls are repaired.
• Frequently done together with removal of the womb through the vagina, when the womb has come down too.
• The bulge and the dragging sensation settle, and bladder or bowel symptoms caused by the bulge usually improve as well.
• Avoid heavy lifting and straining for 4–6 weeks so the repair holds while it heals.

This information supports discussion with your healthcare team. Reading, saving or printing it does not constitute consent to surgery.

About the operation

The vagina is supported by a layer of strong tissue on each side of it. When that layer stretches — after childbirth, with age, with heavy physical work, or after a chronic cough or constipation — the organ behind it presses forward into the vagina and produces a bulge:

• Anterior repair — for a bulge of the front wall, where the bladder has dropped (cystocele). Often associated with urinary symptoms.
• Posterior repair — for a bulge of the back wall, where the rectum presses forward (rectocele), or the small bowel presses in higher up (enterocele). Often associated with difficulty emptying the bowel.

In each case the surgeon opens the vaginal skin over the bulge, tightens the supporting layer beneath it with dissolvable stitches, trims any excess skin and closes it. Nothing is removed but the excess skin, and the repair is made with your own tissue — no mesh is used in the vagina.

Where the womb has also come down, the repair is usually combined with removal of the womb through the vagina. Where the top of the vagina needs support, additional stitches are used — see our sacrocolpopexy guide.

Why it is performed

A prolapse needs treatment only when it troubles you. Surgery is considered when:

• You can feel or see a bulge, or have a dragging, heavy or "something coming down" sensation
• Pelvic floor exercises and a pessary have not given you enough improvement, or you do not want to continue with them
• Bladder symptoms accompany a front-wall bulge — needing to pass urine often, or having to reduce the bulge with a finger before the bladder will empty
• Bowel symptoms accompany a back-wall bulge — having to press on the vagina to empty the bowel, or a feeling of incomplete emptying
• Discomfort during sex, or difficulty keeping a pessary in place

Examination decides which wall (or walls) needs repair and whether the womb or the top of the vagina also needs support — a repair of one wall alone will not hold if the real problem is higher up.

Benefits

• The bulge and the dragging sensation go. This is the operation's main purpose, and the symptom that responds most reliably.
• No abdominal cut — everything is done through the vagina, so there is no abdominal scar and no wound pain of that kind.
• Your own tissue — the repair uses your own supporting layer and dissolvable stitches; no mesh is placed in the vagina.
• Bladder and bowel emptying usually improve where the bulge was the cause — for example no longer having to press on the vagina to empty.
• Can be combined with removal of the womb, or with support to the top of the vagina, in one anaesthetic.

Be aware: a repair corrects the wall it is done on. Tissue support weakens with the years, so a prolapse can appear again — in the same place or in another part of the vagina.

Alternatives

• No treatment for now — a prolapse that does not trouble you needs no operation.
• Pelvic floor muscle training — properly taught and supervised, this helps mild and moderate prolapse and its symptoms, and is worth doing whatever else you decide.
• Vaginal pessary — a support device worn in the vagina and changed periodically in clinic. A good choice when avoiding surgery is preferable, or while you decide.
• Lifestyle measures — treating a chronic cough or constipation, avoiding heavy lifting, and weight reduction where relevant; each reduces the pressure that worsens a prolapse.
• Other operations — where the womb or the top of the vagina is the main problem, removal of the womb through the vagina or a sacrocolpopexy may be more appropriate than repairing a wall alone.

Preparing for surgery

Before the operation you will have a pre-operative assessment: blood tests, blood pressure checks, and a review of your medicines and general health, along with a vaginal examination to plan exactly which repair is needed. Tell the team about all medicines you take — blood thinners may need adjusting — and about any previous prolapse or continence surgery.

• Cervical screening and any bleeding investigations should be up to date and complete before surgery.
• Cough and constipation: treating either beforehand protects the repair, since both raise pressure on it.
• Vaginal oestrogen may be prescribed for a few weeks beforehand to improve tissue quality if you are past the menopause.
• Fasting: exact instructions are given; typically no food from 6 hours before, water up to 2 hours before.
• At home: arrange help for the first two weeks and plan to avoid lifting — including water containers, wet washing and children.

The day of surgery

You are usually admitted on the day of surgery. The team confirms your identity and the planned operation, and you meet the anaesthetist and the surgeon. This is the time for last questions.

You will be asked to sign the consent form, which records the operation, its intended benefits and its risks as they apply to you — including which walls are to be repaired, whether the womb is to be removed at the same time, and what should happen if the examination under anaesthetic shows more prolapse than expected. You can still change your mind at this point. Compression stockings are usually fitted to reduce the risk of blood clots.

During the operation

The operation is usually done under spinal anaesthesia — an injection near the spine numbs you from the waist down; a general anaesthetic is used where a spinal is unsuitable. Either way you feel nothing. Your legs are placed in supports and the bladder is emptied.

Working through the vagina, the surgeon opens the vaginal skin over the bulge, separates it from the layer beneath, and tightens that supporting layer with dissolvable stitches so the bladder or bowel is held back in position. Excess vaginal skin is trimmed and the skin closed, again with dissolvable stitches. If both walls need repair, the same is done front and back. A catheter is placed; a vaginal pack is not usually used. The operation takes around 30–60 minutes whether one or both walls are repaired; a repair combined with removal of the womb takes longer.

After the operation

By the time you wake, the operation is complete. There is no abdominal wound, so what you feel is soreness in the vagina and a deep ache low down rather than wound pain.

• Pain relief: regular simple painkillers control most discomfort; stronger medication is available if needed.
• Catheter: removed once you are fully mobile — usually within 12 hours — and the team then checks that you are passing urine satisfactorily. Passing urine can be slow at first after a front-wall repair.
• Eating and drinking: usually the same day.
• Moving: up and about the same day or the next morning — early walking speeds recovery and protects against clots.
• Bleeding and discharge: light vaginal bleeding and a brown discharge for a few weeks are normal as the internal stitches dissolve.
• Going home: usually the day after surgery, once you are comfortable and passing urine satisfactorily.

Recovery at home

• Week 1: rest, alongside your normal day-to-day activities. Tiredness is normal.
• Week 2 onwards: build your activity up steadily; most women manage as they did before.
• Lifting and straining: avoid both for 4–6 weeks — pressure on a healing repair is what loosens it. Treat constipation promptly; ask for a stool softener if you need one.
• Driving: once you can brake hard without hesitation — commonly around 2 weeks.
• Sex: usually after about 6 weeks, once bleeding and discharge have stopped and the repair has healed.
• Bathing: shower as normal; avoid swimming and sitting in water until the discharge has stopped.
• Pelvic floor exercises: restart once healing allows — they protect the repair long-term.

This guidance covers what is usual; the advice given to you personally takes precedence.

Risks and complications

Every operation carries risk. The figures below are averages from published UK guidance; your individual risk depends on your age, weight, other conditions and previous surgery, and will be discussed with you.

Expected, temporary effects

• Soreness in the vagina and a deep ache low down for the first days
• Light vaginal bleeding and brown discharge for a few weeks as the stitches dissolve
• Some initial hesitancy in passing urine after the catheter is removed

Complications

• Bleeding heavy enough to need a transfusion, or a collection of blood in the repair needing drainage (uncommon).
• Infection — of the urine or the repair; antibiotics are given during surgery to reduce this, and most cases are minor.
• Difficulty emptying the bladder — more common after a front-wall repair; usually short-lived and managed with a catheter for a few days.
• New or worse urinary urgency, or stress leaking that becomes apparent once the bulge is corrected (uncommon).
• Injury to the bladder or bowel — recognised injuries are repaired at the time (rare).
• Blood clots in the leg or lung (VTE) — preventive measures are routine (uncommon).
• Painful sex or narrowing of the vagina — from over-tightening or scarring; uncommon, and the reason a repair is tailored rather than made as tight as possible.
• A stitch problem — persistent discharge or spotting from the healing line; easily treated in clinic (uncommon).
• Prolapse returning, or appearing in another part of the vagina — support weakens with the years; some women need further treatment later.
• Some bladder or bowel symptoms persisting — most improve once the bulge is corrected, but a few can remain; this is discussed before surgery.
• Anaesthetic risks — serious anaesthetic complications are rare.

When to seek help

After you go home, seek medical advice the same day if you notice:

• Heavy vaginal bleeding — bright red, or soaking a pad in an hour
• Foul-smelling vaginal discharge
• Fever (38 °C or higher) or feeling increasingly unwell
• Being unable to pass urine, or passing only small amounts with a full, uncomfortable bladder
• Burning on passing urine
• Worsening pain low down not controlled by your painkillers
• A painful, swollen or red leg

Preparing for your consent discussion

Consent is a conversation, not a signature. Before agreeing to surgery you should feel you understand which walls are being repaired, whether anything else needs doing at the same time, and what to expect for your bladder or bowel symptoms. The checklist below is a starting point — print it and bring it to your consultation.

Sources and review

This page was drafted against the published guidance below. Each reference was live when checked; dates will be confirmed at clinical review.

1. National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. NICE guideline NG123. Available from: https://www.nice.org.uk/guidance/ng123 [last checked 29 July 2026].
2. Royal College of Obstetricians and Gynaecologists. Consent advice — browse all guidance. London: RCOG. Available from: https://www.rcog.org.uk/guidance/browse-all-guidance/consent-advice/ [last checked 29 July 2026].
3. National Health Service (UK). Pelvic organ prolapse. Available from: https://www.nhs.uk/conditions/pelvic-organ-prolapse/ [last checked 29 July 2026].

Patient information from our own clinics

There is no Sugabi or vog.lk article on this topic yet. Related reading:

1. Sugabi Clinic Ragama. Vaginal hysterectomy — Surgery Guide. Available from: https://sugabi.lk/surgery-guide/vaginal-hysterectomy/