ABSTRACT
Damage to or anatomical changes in the posterior vaginal compartment may not be as clinically
apparent as anatomic alterations in the anterior vaginal compartment, yet these abnormalities in
pelvic floor support are clinically relevant in vaginal reconstructive surgery. Identification of
posterior vaginal wall defects during routine gynecologic or urologic evaluation is critical in
planning a definitive therapeutic approach to pelvic reconstruction. While the presence of pos-
terior vaginal wall relaxation, or rectocele, may not necessarily be symptomatic, restoration of
posterior vaginal wall support helps to restore both vaginal axis and function. The normal hori-
zontal position of the proximal half of the vagina is restored, recreating a posterior curvature to
the vaginal axis, thereby preventing progression of pelvic organ prolapse. Changes in intra-
abdominal pressure will allow coaptation and closure of the vaginal vault, providing restored
pelvic floor support for the pelvic organs. Thus, identification and repair of concomitant pos-
terior vaginal wall defects are important in the treatment of symptomatic patients with other
defects in pelvic floor support.
