Rectocele/Posterior Prolapse

What is Rectocele/Posterior Prolapse?

Occurring along the wall separating the rectum and vagina, a posterior prolapse is a herniation, or bulge, that may weaken tissues. Posterior Prolapse, also referred to as Rectoceles, often produces little or no symptoms. For more significant rectoceles, adjacent pelvic organs (small intestine, bladder) may protrude into the vagina and cause discomfort.

What are the Symptoms of Rectocele/Posterior Prolapse?

While rare, rectoceles can be congenital (present at birth). The herniation may also occur due to trauma such as what would be experienced with childbirth or result from chronic coughing or constipation. A prior pelvic injury may also weaken tissue here and increase the susceptibility to herniation. Possible indications of a rectocele may be felt while in the process of making a bowel movement.

Symptoms may also include:

  • Difficulty with bowel movements
  • Sensations of pressure in the rectal area
  • Feeling like a bowel movement hasn’t been completed
  • Sensation of a loss of tone in the vaginal area
  • Pelvic or lower back pain during intercourse

Rectocele/Posterior Prolapse Causes

Rectocele often occurs as a result of trauma to the muscles, tissues and ligaments in between the vagina and the rectum. In most cases this trauma is caused by childbirth, when pelvic floor muscles and tissues throughout the vaginal canal are forced to stretch.

Although rectocele can occur immediately after childbirth, in many cases it doesn’t occur until later on in life. Often this is as a result of the weakening and thinning of muscles, tissues and ligaments which takes place as a natural part of aging. It’s particularly common to experience rectocele after going through the menopause, as this causes a drop in estrogen levels which can lead to weakening and thinning of muscles throughout the body.

It’s also common for rectocele to occur as a result of persistent straining during bowel movements. Often this type of straining is caused by constipation, but chronic coughing and being overweight can also put pressure on the pelvic floor and contribute to rectocele.

How is Rectocele/Posterior Prolapse Treated?

Usually diagnosed during a pelvic or vaginal exam, rectoceles tend to come and go without detection or intervention. It’s only when related issues such as constipation or increased difficulty with bowel movements are experienced that the condition becomes problematic and requires attention. Treatment often involves self-care to allow for natural healing.

Posterior Prolapse Surgery

Typically elective, surgery involves repair of the damaged tissue. Women who have had prior pelvic surgery have lower success rates with corrective surgery. It’s generally recommended to delay surgery if already pregnant or planning to have children.

Some women who have hysterectomies (removal of the uterus) may experience rectoceles. Discomfort can sometimes be minimized by quitting smoking, managing constipation with dietary changes, maintaining a healthy weight, strengthening pelvic muscles with exercise, and avoiding activities or movements that place added stress on the pelvis.

Rectocele/Posterior Prolapse Prevention

The best way to prevent rectocele is to ensure that the muscles, tissues and ligaments in the pelvic region are strong and healthy. Doing regular pelvic floor exercises, often known as Kegels, can help with this process.

Maintaining a strong pelvic floor before having children will help the pelvic region to recover faster after the trauma of childbirth. However, it’s particularly vital to continue with pelvic floor exercises after having children in order to help the pelvic region to recover and reduce the risk of rectocele in the future.

Obesity, chronic coughing and constipation can all also strain the pelvic floor and contribute to weakness and prolapse. It is therefore important to maintain a healthy weight and quit smoking to reduce the risk of developing a chronic cough.

Constipation can be alleviated by eating plenty of fiber and drinking lots of fluids. This will help to make stools soft and easy to pass in order to reduce the need to strain during bowel movements.