A posterior prolapse occurs when the thin wall of fibrous tissue (or fascia) that separates the rectum from the vagina weakens, allowing the vaginal wall to bulge. Posterior prolapse is also called a rectocele because typically, though not always, it is the front wall of the rectum that bulges into the vagina.

Childbirth and other processes that put pressure on the fascia can lead to posterior prolapse. A small prolapse may cause no signs or symptoms. If a posterior prolapse is large, it may create a noticeable bulge of tissue through the vaginal opening. Though this bulge may be uncomfortable, it is rarely painful.

A small posterior prolapse may cause no signs or symptoms. Otherwise, you may notice:

  • A soft bulge of tissue in your vagina that may or may not protrude through the vaginal opening
  • Difficulty having a bowel movement, with the need to press your fingers on the bulge in your vagina to help push stool out during a bowel movement, called “splinting”
  • Sensation of rectal pressure or fullness
  • 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 your vaginal tissue

Many women with posterior prolapse also experience prolapse of other pelvic organs, such as the bladder, uterus, or small intestine.

When a posterior prolapse is small, you do not need medical care. Posterior prolapse is common, even in women who have not had children. In fact, you may not even know you have it. In moderate or severe cases, however, posterior prolapse can be bothersome or uncomfortable. Seek further attention if you have a bothersome bulge of tissue that protrudes from within your vagina through your vaginal opening when you strain, or if constipation treatment is not successful at producing soft and easy to pass stool between three times a day to three times a week.

Posterior prolapse can result from upright posture, increased pelvic floor pressure, and pregnancy/childbirth. Walking upright places weight on a woman’s pelvic floor and is the main reason women experience posterior prolapse. Other conditions and activities that increase the pressure already on the pelvic floor and can cause or contribute to posterior prolapse include chronic constipation or straining, chronic cough, repeated heavy lifting, and being overweight or obese.

Pregnancy and childbirth increase the risk of posterior prolapse. This is because the muscles, ligaments and fascia that hold and support your vagina become stretched and weakened during pregnancy, labor, and delivery. As a result, the more pregnancies you have, the greater your chance of developing posterior prolapse.

Not everyone who has had a baby develops posterior prolapse. Some women have very strong supporting muscles, ligaments and fascia in the pelvis and never have a problem. Women who have only had cesarean deliveries are less likely to develop posterior prolapse. However, even if you have not had children, you can still develop it.

The following factors may increase your risk of experiencing posterior prolapse:

  • Genetics: some women are born with weaker connective tissues in the pelvic area, making them naturally more likely to develop it. Others are born with stronger connective tissues.
  • Childbirth: If you have vaginally delivered multiple children, you have a higher risk of developing posterior prolapse. If you have had tears in the tissue between the vaginal opening and anus (perineal tears) and incisions that extend the opening of the vagina (episiotomies) during childbirth, you may also be at a higher risk.
  • Aging: Your risk of posterior prolapse increases as you age because you naturally lose muscle mass, elasticity, and nerve function as you grow older, causing muscles to stretch or weaken.
  • Obesity: A high body mass index is linked to an increased risk of posterior prolapse. This is likely due to the chronic stress that excess body weight places on pelvic floor tissues.

Doctor Miklos and Doctor Moore are both specialists in posterior repair, and utilize the site specific posterior repair technique, and can add a biologic graft when necessary. A site specific repair simply means to repair the supportive layer whenever it is broken. If you are suffering from a rectocele and are looking for relief, contact Doctors Miklos and Moore today!