Posterior prolapse (rectocele)
Definition:
.jpg "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:
A small posterior prolapse may cause no signs or symptoms. Otherwise, you may notice:
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:
Upright posture
Animals that walk on four legs only rarely get posterior prolapse. The upright weight placed on a woman's pelvic floor 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:
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.
Treatments and drugs:
Treatment approaches depend on the severity of the posterior prolapse. Options include:
Using a vaginal approach, surgery usually consists of removing excess, stretched tissue that forms the posterior prolapse. Occasionally, the surgical repair may involve using a mesh patch to support and strengthen the wall between the rectum and vagina.
If you're thinking about becoming pregnant, delay surgery until after you're done having children. Using a pessary may help relieve your symptoms in the meantime.
Definition:
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:
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
- Anterior prolapse, also known as cystocele, when the front part of the vagina bulges — most commonly it's the bladder that's bulging into the vagina
- Apical prolapse, also known as enterocele, when the top of the vagina is pushed down — most commonly it's the small intestine that's bulging into the vagina
- Uterine prolapse, when the uterus pushes down into the vagina
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.
Upright posture
Animals that walk on four legs only rarely get posterior prolapse. The upright weight placed on a woman's pelvic floor 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 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.
Treatments and drugs:
Treatment approaches depend on the severity of the posterior prolapse. Options include:
- Observation. If your posterior prolapse causes few or no obvious symptoms, you may not need treatment. Simple self-care measures, such as performing exercises called Kegels to strengthen your pelvic muscles, may provide symptom relief.
- Pessary. A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bulging tissues. Several types of pessaries are available, including some you can remove to clean, and others your doctor must remove periodically to clean.
- Surgery. If the posterior prolapse protrudes outside your vagina and is especially bothersome, you may opt for surgery. Surgery to repair posterior prolapse will repair the tissue bulge, but it won't fix impaired bowel function.
Using a vaginal approach, surgery usually consists of removing excess, stretched tissue that forms the posterior prolapse. Occasionally, the surgical repair may involve using a mesh patch to support and strengthen the wall between the rectum and vagina.
If you're thinking about becoming pregnant, delay surgery until after you're done having children. Using a pessary may help relieve your symptoms in the meantime.
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