Posterior prolapse
What is Posterior prolapse?
A posterior vaginal prolapse is a bulge of tissue into the vagina. It happens when the tissue between the rectum and the vagina weakens or tears. This causes the rectum to push into the vaginal wall. Posterior vaginal prolapse is also called a rectocele (REK-toe-seel).
Childbirth-related tears, chronic straining to pass stool (constipation) and other activities that put pressure on pelvic tissues can lead to posterior vaginal prolapse. A small prolapse might not cause symptoms.
With a large prolapse, you might notice a bulge of tissue that pushes through the opening of the vagina. To pass stool, you might need to support the vaginal wall with your fingers. This is called splinting. The bulge can be uncomfortable, but it’s rarely painful.
If needed, self-care measures and other nonsurgical options are often effective. For severe posterior vaginal prolapse, you might need surgery to fix it.
Symptoms
A small posterior vaginal prolapse (rectocele) might cause no symptoms.
Otherwise, you may notice:
- A soft bulge of tissue in the vagina that might come through the opening of the vagina
- Trouble having a bowel movement
- Feeling pressure or fullness in the rectum
- 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 the vaginal tissue
Many women with posterior vaginal prolapse also have prolapse of other pelvic organs, such as the bladder or uterus. A surgeon can evaluate the prolapse and talk about options for surgery to fix it.
Diagnosis
A diagnosis of posterior vaginal prolapse often happens during a pelvic exam of the vagina and rectum.
The pelvic exam might involve:
- Bearing down as if having a bowel movement. Bearing down might cause the prolapse to bulge, revealing its size and location.
- Tightening pelvic muscles as if stopping a stream of urine. This test checks the strength of the pelvic muscles.
You might fill out a questionnaire to assess your condition. Your answers can tell your health care provider about how far the bulge extends into the vagina and how much it affects your quality of life. This information helps guide treatment decisions.
Rarely, you might need an imaging test:
- MRI or an X-ray can determine the size of the tissue bulge.
- Defecography is a test to check how well your rectum empties. The procedure combines the use of a contrasting agent with an imaging study, such as X-ray or MRI.