This blog was updated on 03/06/24
Let’s drop an all-too-common scenario on you, ladies: after the birth of your child, you’re getting a six-week check-up of everything downstairs. Suddenly, your midwife or gynecologist cheerfully announces that you’re the owner of something called a ‘rectocele’ – otherwise known as a posterior vaginal prolapse.
Although it’s surprisingly common – as many as 67% of women who've given birth may have some kind of pelvic organ prolapse (1), very few women recognize the symptoms of posterior vaginal prolapse straight away — so we’re here to help. In this article, we’ll explain exactly what a rectocele is, what causes one, how to spot the signs, and how to treat and prevent vaginal prolapse.
What is posterior vaginal prolapse?
A rectocele (or posterior vaginal prolapse) is a type of pelvic organ prolapse (2), which is where one or more of the organs in the pelvis slips down from its usual position and bulges into the vagina. In the particular case of a rectocele, it’s when your rectum gets pushed right against your vaginal wall.
This may sound like an odd condition, but rest assured that posterior vaginal prolapse is more common than people assume, especially for women who’ve had a vaginal birth or experienced a tear during delivery (3). And because small rectoceles often don’t cause any symptoms (4), it’s difficult for health experts to determine precisely how often they occur. They are, however, very common, although the intensity varies widely.
The good news is that a prolapse isn’t life-threatening. Since it can be a bother and source of discomfort in your day-to-day life, though, it’s important to know what you’re dealing with.
Recognizing the signs of a rectocele
According to the American Society of Colon and Rectal Surgeons, many women who have rectoceles don’t realize it due to the lack of noticeable symptoms (5). And when women do experience vaginal prolapse symptoms, they’re usually mild.
Rectocele symptoms may include:
Difficulty with pooping, and feeling like you haven’t totally emptied your bowels. Sometimes you may need to insert a finger into your vagina (5) or press on your perineum (the space between the anus and vagina) to help evacuate the poop
A general feeling of heaviness or pressure in the vagina or rectum
Feeling or seeing a bulge or some tissue protruding out of your vagina, or feeling a bulge inside if you insert a finger
Feeling the need to poop several times a day, as you're unable to empty your rectum completely
Vaginal bleeding outside of your normal menstrual cycle
Discomfort during sex
What causes posterior vaginal prolapse?
Rectocele causes can vary, but a vaginal prolapse typically results from pressure on the pelvic floor. This can be triggered by a number of factors (6), including:
Pregnancy and giving birth, especially if you've had more than one baby, or a particularly big baby
Frequent straining with bowel movements
Chronic constipation
A chronic cough or bronchitis
A weakening of the pelvic floor muscles after menopause
Gynecological or rectal surgery
Repeated heavy lifting
How to manage and prevent posterior vaginal prolapse
Though posterior vaginal prolapse is common (particularly in women who’ve given birth, and especially in those who’ve done so multiple times), there are ways to help prevent and manage the condition. According to the good folks over at the Mayo Clinic (7), for example, there are certain lifestyle choices that can ease the symptoms of rectoceles and even work to prevent them.
To reduce your risk of experiencing posterior vaginal prolapse, try the following:
Do your pelvic floor exercises regularly. Using a Kegel trainer like Elvie Trainer strengthens your pelvic floor and keeps your pelvic organs in place. We recommend a technique called ‘biofeedback’, which is a special form of pelvic floor therapy aimed at improving Kegel training and showing you how your muscles improve and strengthen over time.
Treat and prevent constipation. A rectocele can sometimes be caused by chronic constipation or frequently straining to evacuate your bowels. You can prevent constipation by drinking plenty of fluids and eating high-fiber foods, and you can often treat it using a stool softener (not a laxative).
Avoid heavy lifting and be sure to lift correctly. Repeated heavy lifting can also contribute to posterior vaginal prolapse, so avoid lifting anything too heavy and be sure to use your legs instead of your waist or back.
Control your coughing. If you’re a smoker, you should try to kick the habit, as chronic coughing can trigger a rectocele. You should also seek treatment for conditions such as bronchitis which can cause you to develop a hacking cough.
Get help from a women’s health physio. Physical therapy can offer long-term relief from prolapse symptoms by strengthening core muscles. These exercises, when used in addition to Kegels to strengthen the pelvic floor, can help to improve your rectocele symptoms.
When does a rectocele require medical treatment?
If your rectocele symptoms are mild, you may not require medical treatment at all. Your doctor or healthcare worker will likely recommend pelvic floor exercises as a first-line treatment option, as strengthening the pelvic floor may help you to manage the condition and provide relief from your symptoms.
For moderate to more severe vaginal prolapse symptoms — for example, if you’re experiencing intense abdominal or lower-back pain or extreme discomfort during sex — your GP may recommend medical treatment. Rectocele treatment may involve the following:
A vaginal pessary. A pessary is a silicone device that is placed directly into the vagina to hold prolapsed organs in place and support bulging tissues. The pessary should be removed, cleaned, and re-inserted regularly to maintain proper hygiene.
Surgery for vaginal prolapse. Surgery may involve removing the extra tissue that forms the bulge in the vagina, with stitches used to support the pelvic structure. This will only be recommended for severe symptoms, or if other pelvic organs are prolapsed along with the rectum.
Whether your symptoms are mild or severe, you should seek the professional advice of your healthcare provider, as they’ll be able to recommend the most appropriate course of action based on the cause of your prolapse and the severity of your symptoms.
Well, there you have it, ladies. Much like “mommy bladder”, rectoceles occur commonly, so you’re not alone and you’re not unusual for having one. There are solutions available to make the situation more manageable, so don’t hesitate to seek advice or a treatment plan from a health expert.
After all, no one really wants their vagina and rectum to be on such intimate terms.
References
Rectocele, Megan Ladd; Faiz Tuma, StatPearls, August 2023
Pelvic organ prolapse, Office of Women's Health, U.S. Department of Health & Human Services, February 2021
Rectocele (Posterior Vaginal Prolapse), Johns Hopkins Medicine
Rectocele, Harvard Health Publishing, August 2023
Rectocele Expanded Information, American Society of Colon and Rectal Surgeons
Rectocele, Cleveland Clinic, March 2022
Posterior vaginal prolapse (rectocele), Mayo Clinic, August 2022