Posterior Vaginal Prolapse (Rectocele): Symptoms and Causes

Posterior Vaginal Prolapse Symptoms: Posterior vaginal prolapse, commonly known as rectocele, is a condition that affects many women, particularly after childbirth or during menopause.

Understanding the symptoms, causes, and potential treatments of rectocele is essential for those who may be experiencing this uncomfortable and often disruptive condition.

What is Posterior Vaginal Prolapse?

Posterior vaginal prolapse, also known as rectocele, occurs when the thin wall of tissue separating the rectum from the vagina weakens. This condition allows the rectal tissue to bulge into the vagina, which can lead to discomfort and complications in bowel movements. It’s a form of pelvic organ prolapse that predominantly affects women, particularly those who have undergone childbirth, hysterectomy, or are experiencing hormonal changes due to menopause.

How It Differs from Other Types of Pelvic Organ Prolapse

Posterior vaginal prolapse is distinct from other types of pelvic organ prolapse in several ways:

1. Location and Affected Organs: Unlike other prolapses that may involve the bladder (cystocele) or uterus, posterior vaginal prolapse specifically involves the bulging of the rectum into the vaginal space.
2. Symptoms: The symptoms of rectocele are unique as they often involve complications related to bowel movements, such as constipation or the need to press on the vaginal wall to evacuate stool.
3. Causes: While all pelvic organ prolapses can be linked to childbirth, aging, and hormonal changes, the stress and damage leading to posterior vaginal prolapse are specifically associated with the posterior part of the pelvic floor.
4. Treatment Options: Treatment for posterior vaginal prolapse may include pelvic floor therapy, which focuses on strengthening the muscles supporting the rectum and vagina. In some cases, surgical options might differ, focusing on the repair of the rectal wall and its separation from the vaginal tissue.

By identifying the specific type of prolapse, healthcare providers can offer the most effective treatments tailored to relieve symptoms and improve quality of life.

Symptoms of Posterior Vaginal Prolapse

This condition can lead to several noticeable symptoms that can affect a woman’s daily life and overall well-being. Understanding these symptoms is crucial for managing the condition effectively and seeking timely medical advice.

Detailed List of Common Symptoms

1. Sensation of Bulging or Heaviness: Women often describe a feeling of pressure or fullness in the pelvic area, which intensifies after long periods of standing or as the day progresses.
2. Difficulty with Bowel Movements: Straining or discomfort during bowel movements is common, as the prolapse can make it difficult to pass stool.
3. Constipation: The prolapse may obstruct the rectal passage, leading to chronic constipation or the need to manually support the vaginal wall to evacuate the bowels.
4. Discomfort or Pain During Intercourse: Sexual activity can be painful or uncomfortable, which may affect intimate relationships.
5. Lower Back Pain: Persistent pain in the lower back, which may feel worse when you are active and lessen when lying down.
6. Vaginal Bleeding or Discharge: Unusual vaginal discharge or bleeding not associated with menstrual cycles can occur.

How These Symptoms Affect Daily Activities

The symptoms of posterior vaginal prolapse can significantly impact daily activities and quality of life:

• Mobility Issues: The discomfort and heavy sensation may limit mobility and discourage physical activity.
• Social Embarrassment: Symptoms like constipation and the need for manual intervention during bowel movements can cause distress and embarrassment, affecting social interactions and activities.
• Sexual Discomfort: Pain during intercourse can lead to a reduction in sexual desire and strain personal relationships.
• Workplace Challenges: Frequent bathroom breaks, discomfort from prolonged sitting or standing, and chronic pain can impair concentration and performance at work.

When to Seek Medical Advice

It is important to consult a healthcare provider if you notice any of the following:

• Persistent Symptoms: If the feelings of bulging, discomfort, or other symptoms persist and interfere with your daily life.
• Worsening Pain: Any increase in pelvic or back pain that becomes hard to manage.
• Bowel Dysfunction: Changes in bowel habits, particularly constipation or straining that doesn’t improve with usual care.
• Impact on Quality of Life: If your symptoms are affecting your quality of life, including your mental health, physical health, or interpersonal relationships.

If you experience any of the symptoms described, it is advised to seek professional medical advice to explore potential treatment options tailored to your specific needs.

Causes and Risk Factors of Posterior Vaginal Prolapse

Understanding the causes and risk factors of posterior vaginal prolapse is crucial for prevention and effective management. Here, we discuss the common causes, main risk factors, and other contributing elements.

Causes of Posterior Vaginal Prolapse

1. Childbirth: The most common cause of posterior vaginal prolapse is damage that occurs to the pelvic muscles during childbirth. Vaginal delivery, especially multiple or complicated deliveries, can significantly stretch or tear the pelvic floor muscles.
2. Chronic Constipation: Frequent straining during bowel movements can put excessive pressure on the pelvic muscles and tissues, leading to weakening over time.
3. Heavy Lifting: Regularly lifting heavy objects can strain pelvic muscles and connective tissues, contributing to the development of a prolapse.
4. Surgical Aftermath: Certain surgeries, like a hysterectomy (removal of the uterus), can affect the support structures of the vagina, which may lead to prolapse.

Risk Factors of Posterior Vaginal Prolapse

1. Age: The risk of developing posterior vaginal prolapse increases with age, particularly after menopause, due to a decrease in estrogen levels which helps maintain muscle strength and elasticity.
2. Obesity: Higher body weight increases the pressure on pelvic organs and muscles, heightening the risk of prolapse.
3. Genetics: A family history of pelvic organ prolapse can predispose individuals to similar conditions due to inherited characteristics of connective tissue.
4. Respiratory Issues: Chronic respiratory problems leading to persistent coughing can exert repeated pressure on pelvic structures, exacerbating the risk of prolapse.

Other Contributing Factors

• Menopause: The drop in estrogen production during menopause can weaken pelvic floor muscles and tissues.
• Hysterectomy: Surgical removal of the uterus can lead to a loss of support for the vaginal walls, potentially resulting in prolapse.
• Chronic Diseases: Conditions like diabetes and connective tissue disorders can affect the strength and elasticity of muscles and tissues in the pelvic area.

However, maintaining a healthy weight, managing chronic conditions, and practicing pelvic floor exercises are some of the strategies that can mitigate the risk of developing this condition.

Complications Associated with Rectocele

Rectocele, a condition often seen in women where the rectal wall protrudes through the weakened vaginal wall, can lead to several health complications if left untreated. Addressing these complications promptly is essential for maintaining quality of life and overall health.

Possible Health Complications If Untreated

1. Chronic Constipation: A common complication of rectocele is chronic constipation. The bulging of the rectal wall can make it difficult for stool to pass through the rectum, leading to persistent constipation. This can result in increased straining during bowel movements, which may exacerbate the rectocele.
2. Rectal Ulceration: In severe cases, prolonged pressure from trapped stool can cause rectal ulceration. This condition can be painful and may lead to bleeding and infection.
3. Pelvic Floor Dysfunction: Untreated rectocele can lead to or worsen existing pelvic floor dysfunction. This can manifest in urinary incontinence, fecal incontinence, and chronic pelvic pain due to the strain and weakening of pelvic muscles and tissues.
4. Progressive Symptoms: Without treatment, the symptoms of rectocele can progressively worsen over time, leading to increased discomfort, pain, and potential complications related to the digestive and urinary systems.

Impact on Sexual Health and Bowel Movements

1. Sexual Discomfort: Rectocele can significantly impact sexual health, leading to discomfort or pain during intercourse. The protrusion into the vagina can make sexual activity uncomfortable or even painful, which may affect sexual relationships and intimacy.
2. Impaired Bowel Movements: The altered anatomy due to a rectocele often results in difficulty having bowel movements. Individuals may experience incomplete evacuation of the bowels, a sensation of blockage, or the need to manually support the pelvic floor (also known as splinting) to complete a bowel movement.
3. Psychological Impact: The chronic nature of rectocele and its effects on bowel and sexual function can also lead to psychological repercussions such as anxiety, depression, and decreased self-esteem due to ongoing discomfort and lifestyle limitations.

However, it’s crucial for individuals experiencing symptoms of rectocele to seek medical advice. Early diagnosis and treatment can help manage symptoms, prevent complications, and improve quality of life.

Diagnosis of Posterior Vaginal Prolapse

Diagnosing this condition accurately is crucial for effective management and treatment. Below, we detail the common diagnostic methods used by healthcare professionals and what to expect during a pelvic exam.

Common Diagnostic Methods Used by Healthcare Professionals

1. Medical History Review: The diagnosis often starts with a thorough review of the patient’s medical history. Healthcare providers will ask about symptoms, such as a feeling of fullness in the pelvis, difficulties with bowel movements, or discomfort during sexual intercourse. They may also inquire about past pregnancies, childbirth experiences, and any previous pelvic surgeries, as these are potential risk factors for developing posterior vaginal prolapse.
2. Physical Examination: A comprehensive physical examination, focusing on the pelvic area, is essential. The doctor will look for any noticeable bulges in the vaginal wall that indicate a prolapse. This examination helps in determining the extent of the prolapse and its impact on surrounding tissues.
3. Pelvic Floor Testing: This may include tests like pelvic floor muscle strength assessments and checking for any connective tissue abnormalities. These tests help to evaluate the functional aspects of the pelvic floor and its supportive structures.
4. Imaging Tests: Although not always necessary, imaging tests like ultrasounds or MRI scans can be used to get a detailed view of the pelvic anatomy. These images help in identifying the exact location and severity of the prolapse, and they can rule out other conditions with similar symptoms.

What to Expect During a Pelvic Exam

1. Preparation: Prior to the pelvic exam, you will be asked to empty your bladder. This makes the examination more comfortable and allows for better assessment. You will then be directed to a private area to remove your clothing from the waist down and provided with a gown or sheet for modesty.
2. Positioning: During the exam, you will lie on an exam table with your knees bent and feet placed in stirrups. This position provides the healthcare provider with the best access to conduct a thorough examination.
3. Visual and Manual Inspection: The healthcare provider will first visually inspect the external genital area for any abnormalities or signs of prolapse. Following this, they will use a speculum, a device designed to widen the vagina, to inspect the vaginal walls and cervix closely.
4. Palpation: The most critical part of the exam involves the provider palpating (feeling) the vaginal walls and pelvic organs. During this process, you may be asked to bear down or cough to better assess the strength of the vaginal walls and pelvic floor muscles.
5. Discussion and Feedback: After the examination, the provider will discuss their findings with you. If a prolapse is detected, they will explain the degree of prolapse and possible treatment options. This is also an opportunity for you to ask questions and express any concerns you may have.

If you suspect you have symptoms of this condition, consult a healthcare professional to begin the evaluation and discuss your treatment options.

Treatment Options for Posterior Vaginal Prolapse

Managing this condition effectively involves a combination of treatments tailored to the severity of the symptoms and the patient’s overall health and preferences. Here, we explore the various treatment options aimed at alleviating symptoms and improving quality of life.

Treatment Goals

The primary objectives in treating posterior vaginal prolapse include:

• Relieving symptoms: This includes discomfort, bulging sensation, and difficulties with bowel movements.
• Restoring function: Improving and maintaining the function of the vaginal and rectal areas.
• Preventing recurrence: Strategies to strengthen pelvic muscles and support structures to prevent future prolapse.

Non-Surgical Treatments

For many women, non-surgical treatments are effective in managing symptoms of posterior vaginal prolapse, especially in milder cases:

1. Pelvic Floor Physical Therapy: Specialized physical therapists can teach exercises designed to strengthen the muscles of the pelvic floor, improving support for the pelvic organs and alleviating symptoms.

2. Pessary: A pessary is a device placed in the vagina to support the bulging tissues. It comes in various shapes and sizes and can be fitted by a healthcare provider to help hold the vaginal walls in place.

3. Lifestyle Modifications:

• Weight management: Reducing body weight can decrease pressure on pelvic structures.
• Dietary changes: High-fiber diets can help prevent constipation, reducing strain during bowel movements.
• Avoiding heavy lifting: Reducing strain on pelvic floor muscles by avoiding heavy lifting and straining during bowel movements.

4. Estrogen Therapy: For postmenopausal women, topical estrogen applied directly to the vagina can help strengthen the tissues around the vagina and rectum.

Surgical Treatments

Surgery may be considered when non-surgical treatments do not alleviate symptoms, or when the prolapse is severe:

1. Rectocele Repair Surgery: This procedure involves tightening the stretched or torn tissue between the rectum and vagina. The surgery can be performed through the vagina or rectum, depending on the specific case and severity.

2. Site-specific Defect Repair: For more targeted treatment, this technique involves repairing specific sites of prolapse rather than a broad surgical approach, which can preserve vaginal structure and function.

3. Sacrocolpopexy: In severe cases involving other forms of pelvic organ prolapse, sacrocolpopexy might be recommended. This involves using a mesh to hold the vaginal vault in the correct anatomical position.

5. Minimally Invasive Surgery: Techniques such as laparoscopic surgery can be used to perform prolapse repairs with smaller incisions, which typically offer quicker recovery times and less pain compared to open surgery.

However, each treatment plan should be tailored to meet the unique needs and goals of the patient, ensuring the best possible outcomes for health and quality of life.

Prevention Tips for Posterior Vaginal Prolapse

Fortunately, there are several strategies you can adopt to prevent or slow its progression. Emphasizing pelvic floor health is crucial in managing and potentially avoiding this condition.

Strategies to Prevent or Slow the Progression of Rectocele

1. Strengthen the Pelvic Floor Muscles: Regularly performing pelvic floor exercises, such as Kegels, can strengthen the muscles and tissues that support the organs in the pelvis. This can help prevent the descent of the rectum into the vaginal wall.
2. Maintain a Healthy Weight: Excess body weight increases pressure on the pelvic floor, which can lead to or exacerbate a rectocele. Managing your weight through a balanced diet and regular exercise can reduce this pressure.
3. Avoid Heavy Lifting: Heavy lifting can strain the pelvic floor muscles. If you must lift, learn proper techniques to minimize stress on these muscles, or use lifting aids whenever possible.
4. Treat and Prevent Constipation: Chronic constipation can put undue pressure on the pelvic floor. Eating a high-fiber diet, drinking plenty of water, and using the bathroom regularly can help maintain bowel health and prevent strain.
5. Quit Smoking: Smoking can lead to persistent coughing, which puts extra stress on the pelvic floor. Quitting smoking will not only help in managing rectocele but will also benefit your overall health.
6. Regular Physical Activity: Engaging in regular, low-impact exercises such as walking, swimming, or cycling can help maintain a healthy weight and improve overall pelvic floor strength.

Importance of Pelvic Floor Health

The health of your pelvic floor is integral to your overall wellbeing. The pelvic floor muscles support several critical organs, including the bladder, intestines, and uterus. Strong pelvic floor muscles help maintain proper organ alignment and function, which is essential in preventing conditions like rectocele. Additionally, a healthy pelvic floor contributes to sexual health and urinary control.

Understanding and maintaining pelvic floor health can lead to significant improvements in quality of life, especially for women at risk of posterior vaginal prolapse. Regular consultations with healthcare providers for personalized advice and routine check-ups can further aid in maintaining pelvic health.

By adopting these preventive measures, you can not only reduce the risk of developing posterior vaginal prolapse but also enhance your overall health and wellbeing.

FAQs about Posterior Vaginal Prolapse Symptoms

1. What is posterior vaginal prolapse?

Posterior vaginal prolapse, also known as a rectocele, occurs when the rectum bulges into the back wall of the vagina due to weakened supporting tissues.

2. What are the common symptoms of posterior vaginal prolapse?

Symptoms often include a sensation of fullness or pressure in the vagina, discomfort during bowel movements, difficulty emptying the bowels, and lower back pain.

3. How is posterior vaginal prolapse diagnosed?

Diagnosis typically involves a pelvic exam by a healthcare provider. They may also use imaging tests like ultrasound or MRI to confirm the condition.

4. What causes posterior vaginal prolapse?

The condition is commonly caused by childbirth, aging, and activities that increase abdominal pressure such as heavy lifting, chronic coughing, or constipation.

5. Can posterior vaginal prolapse be treated without surgery?

Yes, non-surgical treatments include pelvic floor exercises, lifestyle changes to reduce strain, and the use of a pessary, a device inserted into the vagina to support its walls.

6. When is surgery needed for posterior vaginal prolapse?

Surgery may be considered if non-surgical treatments are ineffective and symptoms significantly impact daily life. Surgical options aim to repair and strengthen the vaginal wall.

7. How can I prevent posterior vaginal prolapse?

Preventative measures include maintaining a healthy weight, avoiding heavy lifting, treating chronic coughs promptly, and practicing pelvic floor exercises regularly.

8. Is posterior vaginal prolapse common?

It is relatively common, especially in women who have given birth vaginally, experienced menopause, or are older. It’s important to seek medical advice if you experience symptoms.

Conclusion

In conclusion, a rectocele is a medical condition characterized by the bulging of the rectum into the vaginal wall, which can lead to symptoms such as difficulty with bowel movements, a sensation of pressure or fullness in the pelvis, and discomfort during physical activities or sexual intercourse. The causes of rectocele primarily involve weakening of the pelvic floor muscles due to factors like childbirth, aging, and chronic constipation.

If you suspect you might be experiencing symptoms of a rectocele, it’s essential to consult a healthcare provider. A qualified medical professional can offer an accurate diagnosis and discuss the most effective treatment options tailored to your specific condition. Early consultation can help manage symptoms effectively and improve your overall quality of life. Remember, seeking professional advice is crucial in addressing any health concerns adequately.

References

For further reading and validation of the information provided on Posterior Vaginal Prolapse Symptoms, please refer to the following reputable sources:

1. Mayo Clinic: A comprehensive guide on posterior vaginal prolapse, including symptoms, causes, and treatment options. Read more on Mayo Clinic.
2. Cleveland Clinic: Detailed insights into posterior vaginal prolapse, featuring patient care information and expert advice. Learn more at Cleveland Clinic.
3. WebMD: An easy-to-understand overview of posterior vaginal prolapse symptoms and management. Explore further on WebMD.
4. Johns Hopkins Medicine: In-depth medical information on posterior vaginal prolapse symptoms and treatment recommendations. Visit Johns Hopkins Medicine.
5. NHS UK: Trusted advice and detailed information on posterior vaginal prolapse, including symptom checker and treatment guidelines. Read more on NHS UK.

These resources provide valuable information for understanding and managing posterior vaginal prolapse symptoms effectively.