Posterior colporrhaphy: its effects on bowel and sexual function.

OBJECTIVE: To determine the anatomical cure rate of posterior colporrhaphy and its effect on bowel and sexual function one to six years later.
DESIGN: Retrospective observational study.
SETTING: Urogynaecology Unit, St George's Hospital, London. PARTICIPANTS: Two hundred and thirty-one women who underwent posterior colporrhaphy. MAIN OUTCOME MEASURES: Anatomical and symptomatic cure of rectocoele.
METHODS: The charts of 231 women who underwent 244 posterior colporrhaphies between 1 January 1989 and 4 January 1994 were reviewed. One hundred and seventy one (74%) were interviewed; 140 (61%) were examined. Mean follow up time was 42.5 months (range 11-74).
RESULTS: Two hundred and nine women had prior or concurrent vaginal and/or bladder neck surgery including 38 previous posterior colporrhaphies. Postoperatively prolapse symptoms due to rectocoele decreased (64% vs 31%). Constipation (22% vs 33%), incomplete bowel emptying (27% vs 38%), incontinence of faeces (4% vs 11%) and sexual dysfunction (18% vs 27%) increased. Those with incontinence of stool were more likely to have had two or more posterior colporrhaphies. Sixty-two percent felt that they improved over all after surgery. Additional postoperative symptoms included: vaginal and/or perineal splinting (33%), soiling and/or inability to wipe clean (16%), rectal digitation (23%), incontinence of flatus (19%), and rectal and/or vaginal pain (22%). Thirty-three women (24%) had large rectocoeles, seven of whom did not have impaired bowel emptying.
CONCLUSIONS: Posterior colporrhaphy corrects the vaginal defect in 76% of women. It does not necessarily correct and may contribute to bowel and sexual dysfunction, particularly in those requiring multiple procedures. The presence of the anatomical defect does not imply dysfunction. The prevalence of bowel symptoms suggests the need for close questioning about bowel habits and the selective use of bowel investigations for some women before surgery.