1 What is Posterior Prolapse (Rectocele)?

Posterior prolapse occurs when the thin wall of fibrous tissue (fascial) that separates the rectum from the vagina weakens, allowing the vaginal wall to bulge. It is also known as rectocele because it is mostly the front wall of the rectum.

Childbirth can lead to posterior prolapse. Small prolapses do not have symptoms, but if it is a large prolapse, it might create a bulge of tissue in the vaginal opening, although it is not that painful. Moreover, giving birth to multiple children can weaken your pelvic muscles, which can lead to you developing posterior prolapse. Most of the treatments for this condition are noninvasive and are more to do with physical fitness, various self-care measures, and other non-surgical options.

2 Symptoms

Some of the signs and symptoms of posterior prolapse (rectocele) include:

  • A bulge of tissue in your vagina that causes discomfort
  • A sensation of rectal pressure or fullness, or a feeling of being bloated
  • Difficulty during bowel movements, with the need to push the stool out, as with constipation
  • Feeling you have not yet had a full bowel movement
  • Sexual concerns or sensing looseness in your vaginal tissue

In many cases, women who have posterior prolapse also have prolapses in other areas, such as the small intestine, bladder, or uterus.

You do not need any medical treatment if your prolapse is small. Women who haven’t had children can also suffer from this condition.

Consult your doctor if:

  • Constipation treatment is not successful at producing soft stools three times a day to three times a week.
  • You have a bulge of tissue that extends from your vagina through your vaginal opening.

3 Causes

Posterior prolapse (Rectocele) can be caused by:

  • Walking in an upright position, which places weight on a woman’s pelvic floor
  • Daily activities and other conditions that can increase pressure such as:
  • Repeated heavy lifting, chronic bronchitis, or a cough, as this can cause a prolapse both in young and middle-aged women.
  • Being overweight, which can cause you to experience prolapse more frequently. Simply put, the more you weigh, the more strain your pelvic muscles are under, which can further weaken the pelvic area, leading to posterior prolapse formation.
  • Chronic constipation with bowel movements. This can lead to posterior prolapse forming since you would essentially be straining your pelvic muscles every time you try to void your bowels.
  • Being pregnant: The fascia, muscles, and ligaments that support your vagina are stretched and weakened during pregnancy, labor, and delivery, but not all women develop this condition after giving birth. You can develop it even if you have not had children, but it should be pointed out that you run a greater risk of developing posterior prolapse if you have given birth to multiple children recently.

4 Making a diagnosis

Making a diagnosis of posterior prolapse (rectocele) is done by performing several tests.

Consult your gynecologist if you have any symptoms that are interfering with your normal activities. Bring a family member or close friend with you during your visit for support, if desired. Write down the symptoms you are experiencing, as well as any medications, supplements, and vitamins you are taking. It is vital that you keep your doctor informed regarding your past medical history and what supplements you have been taking as this may have a bearing on the course of treatment for your condition.

Some of the questions you can ask your doctor include:

  • What can I do to ease my symptoms? Is there any immediate relief that I can get from this feeling of being bloated?
  • Do I need any restrictions? Am I allowed to live my life as I have until now, or do I need to make a few changes?
  • What are the chances this will become bigger? Am I at risk for developing other health complications as a result of this condition?
  • What treatment do you recommend? What are the chances of it recurring?
  • What are the risks of a surgical procedure?

Your doctor will also ask you questions such as:

  • What are the symptoms you are experiencing? Can you explain those symptoms with more detail?
  • When did you first notice it? Was it today or much earlier? Did you experience any pain or irritation?
  • Do you leak urine? Do you pass urine without meaning to do so? How often do such episodes repeat themselves?
  • Do you have pelvic pain? Do you go in for regular checkups? Do you visit a gynecologist regularly?
  • Do you have a cough? How long have you had this particular symptom? Is this the first time you are experiencing posterior prolapse?
  • Do you strain and stress your muscles during bowel movements? How often do you void your bowels in the course of a single day?
  • Do you have any other medical conditions? Are you currently taking treatment for them?
  • How many times have you given birth?
  • Do you plan on having children in the future? How many children do you think you would have, over the course of a few years?

Your doctor will diagnose you through some of these tests:

  • Pelvic exam: Your doctor will have you sit as if you are having a bowel movement so that it will bulge and then will check the location and size of it. They will also have you contract your pelvic muscles to check their strength
  • Imaging tests: If your doctor thinks you need further evaluation, they will conduct an MRI or X-ray to determine how efficiently your rectum empties (defecography) and the size of the tissue bulge
  • Questionnaire: A form that you have to fill out for your assessment

5 Treatment

The treatment for posterior prolapse (rectocele) is based on the severity of the posterior prolapse and includes:

  • Observation: You may not need medical treatment if there are no symptoms; you can just do exercises such as Kegel ones to provide relief and strengthen your pelvic muscles
  • Pessary: A rubber or plastic ring is inserted in your vagina to support the bulging tissues and possibly reduce symptoms
  • Surgery: Your doctor will repair the tissue bulge, but it will not fix impaired bowel function

If there is a prolapse with other pelvic organs, your doctor will recommend surgery using a vaginal approach by removing excess and stretched tissues that form the posterior prolapse. Your doctor may suggest you delay the surgery, though, if you want to become pregnant.

6 Lifestyle and coping

Lifestyle modifications are necessary in order to cope with posterior prolapse (rectocele).

You may find comfort and relief in these self-care measures:

  • Do Kegel exercises for the pelvic muscles and to support your fascia: There are many Kegel exercises that you can opt for, from a simple floor exercise to the full stretch. The point of these exercises is to stretch and strain your pelvic muscles, thereby enabling them to support your fascia.
  • Avoid heavy lifting: Try to avoid heavy lifting, as it places undue stress on your upper and lower back. When you lift heavy items, you tend to strain those pelvic muscles, causing you to develop posterior prolapse. Avoiding it should prevent you from having to experience rectocele.
  • Avoid constipation by eating high-fiber foods: Eating foods rich in fiber is a must, more so when you are trying to avoid constipation. For one, fiber-rich foods aid in digestion and enable you to absorb nutrients better. They are also known to remove unwanted toxins from your body.
  • Drink plenty of fluids: Proper hydration is extremely important, especially since it can help you remove toxins from your body and even aid in voiding waste.
  • Avoid bearing down during bowel movements: This can cause the area in that region to develop fissures. Anal fissures are a serious issue and can happen if you strain to move your bowels, so make sure you avoid doing so.
  • Lose weight if you are overweight: It always makes sense to lose excess weight. More so since it can help reduce your risk for other serious health issues such as cancer, heart attacks, strokes, etc. But losing weight should also prevent you from developing posterior prolapse.
  • Control your cough

Kegel exercises will strengthen your pelvic muscles, which support the bladder, uterus, and bowels. A strong pelvic floor will prevent prolapse from worsening and provide better support for your pelvic organs as well as relieve symptoms. The steps in Kegel exercises are:

  • Contract your pelvic floor muscles
  • Hold the contraction for 5 seconds, then relax for 5 seconds (you can start with just 2 seconds if necessary)
  • Eventually, move to holding the contractions for up to 10 seconds at a time
  • Aim for at least 3 sets of 10 each day

Consult your doctor first to make sure you are doing it correctly, or ask a physical therapist to teach you and reinforce with biofeedback. This is done by using monitoring devices that make sure you are tightening the right muscles with the correct length of time and optimal intensity. Since there are no homeopathic medicines available to treat prolapse, you may have to resort to physical therapy as well as undertake certain lifestyle changes to ensure you do not develop rectocele.

It is vitally important that you share all information with your healthcare worker regarding your past medical history, whether you have had any procedures done and if so, for what, and how active you are, sexually. While some of these may seem personal, the fact remains that your doctor needs to know these details in order to diagnose your condition accurately and prescribe the best course of treatment.

7 Risks and Complications

Some of the risk factors that can increase your having a posterior prolapse include:

  • Genetics: Some women are born with weak tissues in the pelvic area. This is why Kegel exercises are important, since they can help you strengthen that particular area. With stronger pelvic muscles, you are less likely to have a prolapse.
  • Childbirth: If you have multiple children, all delivered normally, you are at a higher risk. Women who have given birth multiple times run the risk of developing prolapse, since their pelvic muscles are in a weakened state due to the multiple births.
  • Having perineal tears and incisions that extend in the opening of the vagina (episiotomies): It is always a good idea to pay regular visits to your gynecologist and get yourself checked out regularly to find out if you have perineal tears or incisions, as this can lead to a prolapse.
  • Age: As you age, your risk of having posterior prolapse increases, since your muscles atrophy and become weaker. Because your chances of developing a prolapse increases with age, you need to take effective measures to prevent this from happening.
  • Being overweight: If you are overweight or obese, the excess body weight places pressure on your pelvic floor tissues. The more you weigh, the more mass your pelvic area has to support, which can strain your pelvic muscles until a rectocele develops. So, try to lose that weight and opt for a healthy diet.

8 Related Clinical Trials