Posterior vaginal prolapse

Overview

Posterior vaginal prolapse, also known as rectocele, occurs when the rectum bulges into the vaginal wall. This is a form of pelvic organ prolapse where the support tissue between the rectum and vagina becomes weakened or rips and can no longer hold them in place.

Posterior vaginal prolapse generally affects women regardless of age. However, it is especially common on people with ages 60 and up. Rectocele results from tears during childbirth, chronic constipation and other activities that impose extra pressure on the pelvic floor tissues.

A small prolapse may not have noticeable symptoms. People with large prolapse will feel a bulge into the vagina.  There can be no pain with the bulge, but it can become bothersome. Splinting or using the fingers to support the vaginal wall, can be done by those who are having difficulty to poop due to rectocele.

Both surgical and nonsurgical treatments are available for people with posterior vaginal prolapse. The diagnosis of the doctor will determine the most appropriate treatment for the condition.

Symptoms

Small rectocele may not have symptoms. In moderate or severe cases, common symptoms are:

• A soft bulge of tissue that protrudes through the vagina
• Difficulty having bowel movement
• Rectal fullness or pressure
• Discomfort during intercourse
• Sensation of vaginal looseness
• Requires splinting to help with passing stool
• Feeling the need to pass stool multiple times a day

Surgery may be recommended to treat the rectocele. The doctor will assess possible treatment options and determine potential occurrence of another organ prolapse. Other pelvic organ prolapse, such as uterus or bladder, can occur along with rectocele.

Posterior vaginal prolapse is not painful, however, patients may experience discomfort that can interfere with daily activities. If this happens, visiting a doctor is necessary.

Causes

Rectocele is a result by the weakened or damaged tissue in the pelvis floor. Increased pelvic floor pressure can be caused by:

• Cut or tears during childbirth
• Trauma from operative vaginal deliveries
• Prolonged constipation
• Chronis cough or bronchitis
• Repeated heavy lifting
• Obesity
• Aging
• The tissue in the pelvic floor may be damaged when surgery is undergone on the pelvic organs.

Multiple vaginal childbirth can weaken the pelvic floor muscles. The risk for posterior vaginal prolapse increases with every childbirth, especially with extended labor and large babies. During pregnancy and delivery, the muscles, ligaments, and connective tissue that support the vagina expand. As a result, these tissues are less capable of supporting the pelvic organs.

The occurrence of rectocele is still possible even with cesarean delivery.  Although the risk is relatively less to that of vaginal childbirth.

Risk factors

Generally, women are susceptible to posterior vaginal prolapse. However, several factors can contribute to one’s risk, such as:

• Genetics: Although rectocele is an acquired disease rather than congenital, the quality of connective tissues by birth can affect the likelihood that a person will experience posterior vaginal prolapse.  Inherently, weak tissues will increase the risk.
• Childbirth: Posterior vaginal prolapse has a higher risk to occur when you vaginally deliver more than one child. Episiotomies, perineal tears, and operative vaginal deliveries, particularly the use of forceps can contribute to one’s risk.
• Age: Tissues in the pelvic area weakens as the person gets older. Normally, a decrease in flexibility, muscle mass and nerve function come with aging.
• Weight: A heavier body or being overweight puts extra strain on the pelvic floor muscles.