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Rectocele repair - native tissue, no vaginal mesh.

Repair of a posterior vaginal wall prolapse - transvaginal posterior colporrhaphy, transperineal repair or, in selected cases, STARR. A pelvic-floor consultant, non-surgical options weighed first, and - in line with UK practice since 2018 - no transvaginal mesh.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private rectocele repair costs in the UK.

Indicative ranges across our partner pelvic-floor units.

In short

£4,500–£7,500, home day-case or one night.

Procedure Indicative range
Transvaginal posterior colporrhaphy (native tissue) £4,500–£7,500
Transperineal rectocele repair £5,500–£8,500
STARR (transanal stapled repair) £6,000–£9,000
Rectocele repair with concurrent perineorrhaphy £5,500–£9,000
Pessary fitting and review £250–£450
Defaecating proctography or dynamic pelvic MRI £400–£950
Pelvic floor consultation only £250–£450

Prices vary by hospital, by the consultant, by approach (transvaginal, transperineal, transanal), and by whether a perineorrhaphy or combined prolapse repair is done at the same sitting.

The problem

The right diagnosis, the right sequence, the right hands.

Rectocele is where posterior-compartment care is quietly under-served - pessary and physio skipped, repairs over-tightened, coexisting prolapses missed.

  • Physio and pessary first

    Not every rectocele needs surgery. A supervised physio and pessary trial for 6–12 weeks is standard first-line care.

  • Look at the whole pelvic floor

    Rectocele rarely comes alone - coexisting cystocele, uterine descent or enterocele change the operation.

  • Do not over-tighten

    A tight posterior repair causes dyspareunia. Surgical judgement - and not over-doing it - matters more than any bit of kit.

When it helps

When rectocele repair is the right step.

The situations we see most, plus the red flag that needs urgent - not routine - assessment.

  • A vaginal bulge you can see or feel

    Posterior vaginal wall prolapse - the rectum pressing into the back of the vagina - noticeable on straining, standing at the end of the day, or during intercourse.

  • Obstructed defaecation

    Straining hard, feeling incomplete emptying, needing to strain repeatedly. The classic mechanical symptom of a rectocele.

  • Splinting to open your bowels

    Pressing on the perineum, into the vagina, or on the buttocks to complete a bowel motion - a specific, telling symptom of a symptomatic rectocele.

  • Dyspareunia (pain with sex)

    Bulge, discomfort or awareness of the prolapse during intercourse - often the reason younger patients seek repair.

  • After childbirth, or years later

    Rectocele is common after vaginal delivery, especially with instrumental birth or perineal injury. It can develop or worsen many years afterwards.

  • Failure of physiotherapy or pessary

    A supervised trial of pelvic floor physio and, where suitable, a pessary - if symptoms persist and quality of life is affected, surgery is reasonable.

  • Combined pelvic floor prolapse

    Rectocele rarely comes alone - cystocele, uterine descent or enterocele often coexist. Repair may need combined colorectal and urogynaecology input.

  • Red flag: bleeding, ulceration, incontinence

    Vaginal or rectal bleeding, a prolapse that will not go back, ulcerated tissue or new faecal incontinence needs urgent review - not a routine appointment.

Procedure options

Non-surgical options weighed first, then the right repair.

What each option involves - pessary and physio, transvaginal colporrhaphy, transperineal repair, STARR, biological grafts and combined prolapse work.

  • Transvaginal posterior colporrhaphy

    The standard UK operation. Through the back wall of the vagina, the surgeon plicates the fibromuscular layer between rectum and vagina using native tissue and dissolvable sutures. No mesh.

  • Site-specific fascial repair

    A variation of colporrhaphy that identifies and repairs specific defects in the rectovaginal fascia rather than a generic midline plication. Sometimes preferred for focal rectoceles.

  • Transperineal repair

    Through a perineal incision, combining rectocele repair with perineal body reconstruction (perineorrhaphy). Useful where the perineal body itself is deficient.

  • STARR (Stapled Transanal Rectal Resection)

    A transanal circular stapler resects a full-thickness ring of redundant rectal wall. Used in selected cases of obstructed defaecation with internal intussusception plus rectocele - patient selection is critical.

  • Biological graft augmentation

    Where tissue quality is poor or the patient has had failed native-tissue repair, a biological (not synthetic) graft may be used. A specialist decision made only after full counselling.

  • Pessary - the non-surgical option

    A silicone device fitted in the vagina to support the posterior wall. Excellent for patients who wish to avoid surgery, are unfit for it, or want to try before deciding. Requires periodic changes.

  • Pelvic floor physiotherapy

    Specialist supervised pelvic floor training, biofeedback and defaecation retraining. Effective for mild-to-moderate cases and always continued after surgery to protect the repair.

  • Combined prolapse repair

    Where cystocele, uterine prolapse or enterocele coexist, a combined operation planned jointly by urogynae and colorectal may be more durable than a rectocele repair alone.

Safety and recovery

What to expect afterwards - honestly.

Rectocele repair is generally low-risk day-surgery. The things worth planning are the physio afterwards, the sexual-function conversation, and - where relevant - the pessary alternative.

  • GA in a proper theatre, with a pelvic-floor team

    Repairs are usually under general anaesthetic, occasionally spinal. Day-case or one night is standard for uncomplicated repairs.

  • Bleeding, haematoma and infection

    Vaginal or perineal wound infection under 5 percent. Small vaginal haematoma is common and usually settles. Fever, spreading pain or heavy bleeding needs same-day review.

  • Dyspareunia after repair

    A tight repair can cause new or worsened pain with sex - one of the most important risks to discuss. Surgical technique matters; so does not over-tightening. Physio and gradual return to intercourse help.

  • Recurrence over time

    Recurrence at 5 years is 10–20 percent after transvaginal colporrhaphy and higher if pelvic floor training is not maintained. STARR outcomes vary and it is used in selected cases only.

  • Bowel function change

    Some patients notice tenesmus, urgency or altered emptying - usually settling over 3–6 months. STARR in particular is associated with these symptoms.

  • Bladder or ureteric injury

    Rare in posterior repairs but not zero, especially with combined anterior compartment work. Under 1 percent.

  • No vaginal mesh in UK practice

    Transvaginal synthetic mesh for prolapse was paused in the UK in 2018 and remains so - we do not use it. Biological grafts are considered only in selected recurrent cases with full consent.

  • Long-term maintenance is you, not the surgeon

    Weight, avoiding heavy lifting, treating constipation and ongoing pelvic floor exercise are the single biggest predictors of a durable repair. Physio is not optional.

  • Red flags after surgery

    Heavy vaginal bleeding, fever, unable to pass urine, severe pain not settling on analgesia, breathlessness or calf pain need the same-day team or A&E, not a routine call.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever approach was used - transvaginal, transperineal or transanal - the note the surgeon sends you keeps to the same shape.

A UK consultant reviewing a patient’s operation notes

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the operation note and the follow-up plan before your review, just ask.

  1. 01 Header

    Indication, prolapse grade and approach

    Why the repair was done, the rectocele grade and any coexisting prolapse, and whether the approach was transvaginal, transperineal or transanal (STARR).

  2. 02 Technique

    Repair technique and materials

    Whether a midline plication or site-specific fascial repair, whether a perineorrhaphy was added, and - where relevant - the type of biological graft used. No synthetic vaginal mesh in current UK practice.

  3. 03 Findings

    Pelvic floor findings and adjuncts

    What was seen at surgery - enterocele, intussusception, perineal body defect - and whether combined anterior compartment or uterine work was needed.

  4. 04 Impression

    Follow-up, physiotherapy and precautions

    Read this first: post-operative precautions (no lifting, no penetration for 6 weeks), the pelvic floor physiotherapy plan, and the follow-up schedule.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Rectocele repair is usually covered when medically indicated and after a documented physiotherapy or pessary trial.

Frequently asked

Everything we get asked about rectocele repair.

Quick answers on physio, pessaries, mesh, sex, cost and NHS comparison.

  • What is a rectocele and how is it different from other prolapses?

    A rectocele is a posterior vaginal wall prolapse - the front wall of the rectum bulges into the back wall of the vagina because the fibromuscular tissue between them has weakened. It is different from a cystocele (bladder into front wall of vagina), uterine prolapse (womb descending), or full-thickness rectal prolapse (rectum coming out of the anus). The symptoms and repair are all different, which is why an accurate diagnosis matters.

  • Do I need surgery, or will physio and a pessary help?

    Not everyone needs an operation. For mild to moderate rectoceles, a supervised 6–12 week trial of specialist pelvic floor physiotherapy - with a pessary if it fits your life - is usually the first step. Surgery is reasonable for larger or symptomatic prolapses that do not respond, or where obstructed defaecation and splinting are affecting quality of life. It is a joint decision after assessment, not automatic.

  • Is vaginal mesh used for rectocele repair in the UK?

    No. Transvaginal synthetic mesh for pelvic organ prolapse has been paused in the UK since 2018, following the Cumberlege Independent Medicines and Medical Devices Safety Review. Modern UK rectocele surgery uses native tissue (your own tissue) - a posterior colporrhaphy or site-specific fascial repair. Biological grafts may be considered in selected recurrent cases with full counselling.

  • Will surgery affect sex?

    Repair can improve symptoms of bulge or discomfort with intercourse, but it can also cause new or worsened dyspareunia if the repair is too tight. A skilled surgeon avoids over-tightening. Most patients return to intercourse gradually from 6 weeks; some benefit from post-operative physio and use of lubricant. We ask about baseline sexual function so any change is recognised.

  • How much does private rectocele repair cost in the UK?

    Roughly £4,500–£7,500 for transvaginal posterior colporrhaphy, £5,500–£8,500 for transperineal repair, and £6,000–£9,000 for STARR (transanal stapled repair, in selected cases only). A pessary trial is £250–£450 per fitting.

  • How does this compare to the NHS pathway?

    NHS urogynae and pelvic floor units offer the same operations to the same UK guidance - no vaginal mesh, physiotherapy first, pessary options, and specialist repair. Private care buys shorter waits, choice of consultant, and single rooms - not a different operation. Many patients move between the two pathways, particularly for the initial physio and pessary trial.

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