Disorders of the posterior pelvic floor are associated with disturbances in the integrity of the pelvic floor musculature and disordered defecation. Since the early nineteenth century, surgeons have performed posterior colporrhaphy to manage tears of the perineum. The supports of the genital organs were largely a mystery, and there was little distinction between prolapse of the rectum, bladder, and uterus. As anatomic concepts developed, surgeons ascertained that the main support of the uterus was the vagina, which in turn is supported by the insertion of the levator ani muscles into the perineum. This concept was the basis for the incorporation of plication of the levator ani muscles into posterior colpoperineorrhaphy, with the surgical goals of restoring the anatomic support of the vagina and rectum without compromising functionality. Until recently, very little attention has been given to the functional derangements that are commonly associated with rectoceles.