Posterior compartment prolapse is a herniation of the posterior vaginal wall or anterior rectal wall into the lumen of the vagina. It is often seen in association with pelvic floor dysfunction and vaginal prolapse, and requires special consideration for its treatment. Rectocele repairs can be approached via the abdominal, transvaginal, and transanal approaches. The goals of posterior compartment prolapse repair are to restore anatomy while minimizing hemorrhage, dyspareunia, rectal injury, and mesh erosion. This chapter provides guidance for preoperative planning, intraoperative avoidance, and the management of the complications encountered with posterior compartment repair.