Posterior Vaginal Prolapse (Rectocele) – Symptoms and Causes

Overview

Posterior vaginal prolapse, also known as rectocele, is a condition in which the supportive wall between the rectum and the vagina becomes weakened. As a result, the rectum may bulge into the back wall of the vagina.

This condition is a type of pelvic organ prolapse and is more common in individuals who have experienced childbirth, aging, or changes in pelvic floor strength.

Although it can vary in severity, rectocele is a recognized structural change within the pelvic region that affects many women worldwide.

Signs and Issues

Symptoms of posterior vaginal prolapse can vary depending on the severity. Small prolapses may not cause noticeable discomfort, while larger prolapses can lead to more obvious changes.

Common signs and issues include:

• A soft bulge of tissue in the vagina, which may extend to or through the vaginal opening
• A feeling of pressure or fullness in the rectal area
• Difficulty with bowel movements, sometimes requiring the use of fingers to press against the vaginal wall (a technique called splinting)
• A sensation of incomplete rectal emptying after a bowel movement
• Concerns during intimacy, such as embarrassment or a feeling that vaginal tissue is looser

Most people describe the bulge as uncomfortable rather than painful. Some women may experience multiple types of pelvic organ prolapse at the same time.

When Medical Help Is Needed

Minor posterior vaginal prolapses often cause no problems and may not require treatment. However, moderate to severe cases can create significant discomfort and affect your quality of life.

Contact your healthcare provider if:

• Symptoms interfere with your daily activities
• You feel persistent discomfort
• The prolapse seems to be worsening

Early evaluation allows for more treatment options and better outcomes.

Causes

Pregnancy and birth can weaken the support structures of the vagina. During these times, the muscles, ligaments, and tissues that hold the vagina in place get stretched. This stretching makes these structures less supportive.

Women who have had more pregnancies face a higher risk of developing posterior vaginal prolapse. The repeated stretching during multiple pregnancies further weakens these support structures.

Women who have only had Cesarean deliveries (C-sections) have a lower risk, but can still develop this condition. Other factors that put pressure on the pelvic floor include:

• Tears during childbirth
• Use of forceps during delivery
• Ongoing constipation
• Chronic coughing
• Regular heavy lifting
• Excess body weight

These factors can all contribute to weakening of the pelvic support system over time.

Risk Factors

Several factors can lead to this condition. Childbirth-related tears are a common cause. Chronic constipation that leads to straining during bowel movements can also weaken the tissue over time.

Other activities that increase pressure on pelvic tissues may contribute as well.

Several factors can raise your chance of getting posterior vaginal prolapse:

• Genetic factors play a key role. Some women are born with naturally weaker connective tissues in their pelvic region, making them more likely to develop this condition.
• Childbirth experiences significantly impact risk:
  • Having multiple vaginal deliveries
  • Experiencing perineal tears during delivery
  • Having episiotomies (surgical cuts to enlarge the vaginal opening)
  • Deliveries using instruments, especially forceps
• Age-related changes contribute as well. As women get older, they naturally lose muscle mass and elasticity. Their nerve function also decreases, which weakens pelvic floor muscles.
• Weight concerns matter too. Being overweight or obese puts extra pressure on the pelvic floor tissues. This added stress can weaken the structures that support the vagina and rectum.

Prevention

To prevent posterior vaginal prolapse from worsening, consider these helpful strategies:

• Strengthen Your Muscles: Do Kegel exercises regularly to build up pelvic floor strength. This is especially important after childbirth.
• Manage Bowel Habits: Prevent constipation by drinking enough water and eating fiber-rich foods. You can find fiber in fruits, vegetables, beans, and whole grains.
• Use Proper Techniques: When lifting heavy objects, bend at your knees and use your leg muscles. Avoid straining your back or waist.
• Address Respiratory Issues: Seek treatment for chronic cough or bronchitis. Also, avoid smoking to reduce pressure on pelvic organs.
• Maintain a Healthy Weight: Work with your healthcare provider to determine your ideal weight. Then, develop a plan for weight management if needed.