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Posterior prolapse (rectocele)

A posterior prolapse occurs when the thin wall of fibrous tissue (fascia) that separates the rectum from the vagina weakens, allowing the vaginal wall to bulge. Posterior prolapse is also called a rectocele (REK-toe-seel) because typically, though not always, it's the front wall of the rectum that bulges into the vagina.

Childbirth and other processes that put pressure on the fascia can lead to posterior prolapse. A small prolapse may cause no signs or symptoms. If a posterior prolapse is large, it may create a noticeable bulge of tissue through the vaginal opening. Though this bulge may be uncomfortable, it's rarely painful.

If needed, self-care measures and other nonsurgical options are often effective. In severe cases, you may need surgical repair.

Symptoms Causes Risk factors Prevention

A small posterior prolapse may cause no signs or symptoms. Otherwise, you may notice:

  • A soft bulge of tissue in your vagina that may or may not protrude through the vaginal opening
  • Difficulty having a bowel movement with the need to press your fingers on the bulge in your vagina to help push stool out during a bowel movement ("splinting")
  • Sensation of rectal pressure or fullness
  • A feeling that the rectum has not completely emptied after a bowel movement
  • Sexual concerns, such as feeling embarrassed or sensing looseness in the tone of your vaginal tissue

Many women with posterior prolapse also experience prolapse of other pelvic organs, such as the bladder, uterus or small intestine.

When to see a doctor

When a posterior prolapse is small, you don't need medical care. Posterior prolapse is common, even in women who haven't had children. In fact, you may not even know you have posterior prolapse.

In moderate or severe cases, however, posterior prolapse can be bothersome or uncomfortable. Make an appointment with your doctor if:

  • You have a bothersome bulge of tissue that protrudes from within your vagina through your vaginal opening when you strain
  • Constipation treatment isn't successful at producing soft and easy-to-pass stool between three times a day to three times a week

Posterior prolapse can result from:

Upright posture

Walking upright places weight on a woman's pelvic floor and is the main reason women experience posterior prolapse.

Increased pelvic floor pressure

Other conditions and activities that increase the pressure already on the pelvic floor and can cause or contribute to posterior prolapse include:

  • Chronic constipation or straining with bowel movements
  • Chronic cough or bronchitis
  • Repeated heavy lifting
  • Being overweight or obese

Pregnancy and childbirth

Pregnancy and childbirth increase the risk of posterior prolapse. This is because the muscles, ligaments and fascia that hold and support your vagina become stretched and weakened during pregnancy, labor and delivery. As a result, the more pregnancies you have, the greater your chance of developing posterior prolapse.

Not everyone who has had a baby develops posterior prolapse. Some women have very strong supporting muscles, ligaments and fascia in the pelvis and never have a problem. Women who have only had cesarean deliveries are less likely to develop posterior prolapse. But even if you haven't had children, you can develop posterior prolapse.

The following factors may increase your risk of experiencing posterior prolapse:

  • Genetics. Some women are born with weaker connective tissues in the pelvic area, making them naturally more likely to develop posterior prolapse. Others are born with stronger connective tissues.
  • Childbirth. If you have vaginally delivered multiple children, you have a higher risk of developing posterior prolapse. If you've had tears in the tissue between the vaginal opening and anus (perineal tears) and incisions that extend the opening of the vagina (episiotomies) during childbirth, you may also be at higher risk.
  • Aging. Your risk of posterior prolapse increases as you age because you naturally lose muscle mass, elasticity and nerve function as you grow older, causing muscles to stretch or weaken.
  • Obesity. A high body mass index is linked to an increased risk of posterior prolapse. This is likely due to the chronic stress that excess body weight places on pelvic floor tissues.

To reduce your risk of worsening posterior prolapse, try these self-care measures:

  • Perform Kegel exercises on a regular basis. These exercises can strengthen your pelvic floor muscles — especially important after you have a baby.
  • Treat and prevent constipation. Drink plenty of fluids and eat high-fiber foods, such as fruits, vegetables, beans and whole-grain cereals.
  • Avoid heavy lifting and lift correctly. When lifting, use your legs instead of your waist or back.
  • Control coughing. Get treatment for a chronic cough or bronchitis, and don't smoke.
  • Avoid weight gain. Talk with your doctor to determine your ideal weight and get advice on weight-loss strategies, if you need them.
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