Posterior vaginal prolapse

Diagnosis

A healthcare provider starts the diagnosis of rectocele with assessing the patient’s medical history and performing a physical exam.

Diagnosis often involves a pelvic exam. The doctor may require the patient to:

• Bear down: Same position with having a bowel movement to show the size and location of the prolapse. The prolapse will become more visible due to the applied pressure.
• Tighten the pelvic muscles: Like stopping a stream of urine. Squeezing and relaxing the pelvic floor muscles will determine how strong it is.

The doctor shall evaluate the extent to which the condition has impacted the well-being of the patient. The treatment decision will be based on this information. In some cases, imaging tests may be required:

• MRI or an X-ray: can provide a good visualization of the size of the rectocele.
• Defecography: is a special X-ray that measures how efficiently the rectum empties. A contrasting agent is used in combination with other tests, like X-ray or MRI. It can reveal the extent of a rectocele.

Treatment

Several treatments are available to fix a rectocele. The doctor shall diagnose the severity of the prolapse to determine the appropriate treatment. It is often composed of:

• Observation: Noninvasive treatments are available to treat a small rectocele with little to no symptoms. The prolapse can be managed by making the pelvic floor muscles stronger, usually in a form of Kegel exercises and bowel training.
• Vaginal Pessary: This is a removable device, made in silicone, that is fitted into the vagina to support the area of a prolapse. Usually, the patient is instructed on how to care, remove, and insert the pessary. This is often recommended for moderate and severe cases of rectocele.

Surgery

A surgical rectocele repair may be recommended in instances that:

• A vaginal pessary and pelvic exercises such as Kegel, did not improve the symptoms of rectocele.
• A secondary prolapse occurred along with rectocele.  If the symptoms are uncomfortable, the doctor may need to fix all affected organs to restore quality of life.

During a rectocele repair, the vaginal bulge is removed. The doctor will take out the excess tissue and stabilized the healthy tissues through sutures. In cases where another prolapse is present, a doctor can do multiple repairs in one surgery. For instance, prolapse of uterus may require hysterectomy.

Kegel exercises

Kegel exercises can improve the health of pelvic floor muscles and can also help manage the symptoms of posterior vaginal prolapse.

To do a Kegel:

• Find the right muscles. The pelvic floor muscles are located between the pubic bone in front up to the end of spine at the back, forming a small sling. While peeing, try to stop the flow of urine. If the correct muscles are successfully identified, the patient may start with the exercise. Lying down position is recommended for beginners.
• Correct technique. When performing Kegels, start lifting and holding for three second, then release and relax for three seconds. Visualize sitting on a marble and contract the pelvic muscles as if raising the marble. Patients may gradually add several exercises per set as they improve.
• Maintain focus. Breathe out while performing the exercises, avoid holding breath. Make sure not to press or tighten the muscles in abdomen, back, buttocks, or inner thighs. If these muscles are contracted, the exercise is not executed properly. Focus on squeezing the correct muscles.
• Repeat three sets a day. One set may consist of 10 to 15 repetitions in a row. Patients may reduce or increase this number depending on their strength and endurance.

Some patients may find it hard to do Kegel exercises. A biofeedback training administered by a healthcare professional will help determine if the exercises are done properly. A monitoring device or probe is inserted into the vagina to ensure that the correct muscles are tightened during the session. In time, this will improve the pelvic floor muscles.