Posterior Vaginal Prolapse (Rectocele)

A rectocele is a type of vaginal prolapse. It happens when the tissue separating the vagina from the rectum weakens or tears. This weakening allows the rectum, the part of your digestive system that stores stool, to push into the vagina. Imagine a wall between two rooms weakening, and one room slightly bulging into the other. That's essentially what's happening.

This bulging can sometimes be noticeable as a lump or bulge coming out of the vagina. It can also make bowel movements more difficult, as the bulging rectum may need to be supported with your fingers to pass stool. This is called splinting. The bulge itself isn't usually painful, but it can be uncomfortable.

Most cases of rectocele can be managed without surgery. Simple self-care measures, like pelvic floor exercises, can often help. In more severe situations, where the prolapse is large or causing significant discomfort, surgery may be needed to repair the weakened tissue and prevent the rectum from bulging into the vagina.

A small bulge in the back of the vagina (rectocele) might not cause any problems.

However, if it's noticeable, you might experience:

• A bulge in the vaginal opening: A soft, fleshy lump might appear protruding from the vaginal opening.
• Difficulty with bowel movements: It can make going to the bathroom harder.
• Incomplete bowel emptying: You might feel like you haven't emptied your bowels completely after using the restroom.
• Concerns about sex: Some women experience embarrassment or a feeling of looseness in the vaginal area, affecting their comfort during sex.

Often, a rectocele is connected to other pelvic organ prolapses, like a prolapse of the bladder or uterus. A doctor, likely a specialist like a gynecologist or urogynecologist, can assess the extent of the prolapse and discuss various treatment options, including surgery.

A posterior vaginal prolapse is a condition where the back wall of the vagina weakens and drops. Sometimes, this doesn't cause any problems at all. However, if the prolapse is moderate or severe, it can lead to discomfort. This discomfort might involve pain, pressure, or a feeling of something bulging. If these symptoms are impacting your daily activities, it's important to see a doctor or other healthcare professional. They can properly diagnose the issue and discuss treatment options.

Vaginal Prolapse: Understanding the Risk Factors

Pregnancy, labor, and delivery put a lot of stress on the tissues that support the vagina. These tissues, including muscles, ligaments, and connective tissue, stretch to accommodate the growing baby. This stretching can weaken them, making them less able to hold everything in place. Think of it like a rubber band being stretched repeatedly – it might not be as strong as it once was. Having more pregnancies means more stretching and a higher risk of these supportive tissues becoming weaker.

Having a baby vaginally (with forceps or other assistance) can also increase the risk. The stress on the tissues during labor and delivery can contribute to weakening. Similarly, long-lasting conditions like chronic constipation (where you strain a lot during bowel movements) or a persistent cough (like from bronchitis) can put extra strain on the pelvic floor muscles. Heavy lifting, especially when done frequently, can also make a difference. Being overweight adds more pressure on the pelvic floor, putting additional stress on these supportive tissues.

While having only Cesarean deliveries lowers your risk of this condition, it doesn't eliminate it entirely. Even with no vaginal deliveries, the tissues can still weaken over time due to the factors listed above.

Posterior vaginal prolapse, a condition where the back wall of the vagina sags, can happen to anyone with a vagina. Several factors can increase the likelihood.

Family History (Genetics): Some people inherit weaker tissues in their pelvic area. This means their pelvic floor muscles and supporting tissues might naturally be less strong, making them more vulnerable to prolapse. Imagine a hammock with weak ropes; it's more likely to sag under weight.

Childbirth: Having multiple vaginal deliveries is a significant risk factor. This is because vaginal childbirth can stretch or damage the tissues supporting the vagina and rectum. Tears in the perineum (the area between the vagina and anus), or episiotomies (surgical cuts made during childbirth to widen the vaginal opening), can weaken these tissues. Even assisted deliveries, such as those using forceps, can increase the risk.

Age: As we get older, our bodies naturally lose muscle mass, flexibility (elasticity), and nerve function. This can weaken the pelvic floor muscles, making them less able to support the vagina and rectum. Think of your muscles like rubber bands; with age, they lose their strength and stretchiness.

Weight: Being overweight or obese puts extra pressure on the pelvic floor tissues. This added weight can strain the muscles and ligaments that support the vagina and rectum, increasing the risk of prolapse. Imagine a heavy bag placed on a weak table; it's more likely to cause the table to bend or break.

To help prevent a sagging vagina (posterior vaginal prolapse) from getting worse, there are several things you can do:

• Strengthen your pelvic floor muscles. Regular Kegel exercises are key. These exercises work the muscles that support your vagina, bladder, and bowel. It's especially important to do them if you've had a baby. Kegels can help prevent further weakening of these muscles.

• Manage your bowel movements. Constipation can put extra pressure on your pelvic floor. Drinking plenty of water and eating foods rich in fiber, like fruits, vegetables, beans, and whole grains, can help keep things moving smoothly. If you have ongoing constipation issues, talk to your doctor.

• Lift properly. Avoid lifting heavy objects, and if you do have to lift, use your legs to do it, not your back. Lifting with your back can put a lot of strain on your pelvic floor muscles. Proper lifting technique is crucial to protect your body.

• Control coughing. A persistent cough, like from bronchitis or smoking, puts pressure on your pelvic floor. If you have a chronic cough, talk to your doctor about treatment options. Quitting smoking is also important for overall health, including pelvic floor health.

• Maintain a healthy weight. Extra weight can put extra stress on your pelvic floor. Work with your doctor to determine a healthy weight for you and get advice on how to reach and maintain it. If you need to lose weight, your doctor can help you create a safe and effective plan.

By following these tips, you can help keep your pelvic floor muscles strong and healthy, reducing the risk of further vaginal prolapse. Remember to always talk to your doctor before starting any new exercise or weight loss program.

Doctors often find posterior vaginal prolapse during a routine pelvic exam. A pelvic exam checks the vagina and the area around it. Part of this exam might involve:

• Pushing down: You might be asked to push down as if you were having a bowel movement. This helps the doctor see how far the prolapse extends into the vagina and how big it is. This is because pushing can make the bulge more noticeable.
• Squeezing muscles: The doctor might also ask you to squeeze your pelvic muscles as if you were trying to stop urinating. This helps them assess how strong your pelvic floor muscles are. Strong muscles are important for supporting the vagina and other organs in the pelvis.

To understand the effect of the prolapse on your daily life, you may also complete a questionnaire. This questionnaire asks about how much the prolapse bothers you and how far it extends into the vagina. This information helps your doctor decide on the best treatment plan.

Sometimes, more detailed pictures are needed. These are rarely necessary, but may include:

• MRI or X-ray: An MRI (magnetic resonance imaging) or an X-ray can create detailed pictures to show the size and location of the prolapse. These images can help your doctor see how much of the tissue is bulging.
• Defecography: This test checks how well your rectum empties during bowel movements. Defecography uses a special dye (contrast agent) that shows up on an X-ray or MRI image. This dye helps the doctor see how the rectum and surrounding tissues move during bowel movements. It helps them understand if the prolapse is affecting your ability to empty your bowels.

By using a combination of these methods, your doctor can get a clear picture of your condition and choose the best treatment option for you.

Pelvic organ prolapse (POP) happens when tissues in the pelvis, like the bladder, uterus, or rectum, drop down and bulge into the vagina. One way to help support these tissues is using a pessary.

Pessaries are different shapes and sizes of devices that fit inside the vagina. They provide support for tissues that have moved out of place due to prolapse. A doctor will help you choose the right pessary for your situation.

How your prolapse is treated depends on how bad it is and how it affects you. Here are some options:

• Watching and waiting (observation): If the prolapse isn't causing many problems, simple self-care can sometimes help. This might include doing Kegel exercises to strengthen the muscles of your pelvic floor. These exercises help the muscles hold everything in place.

• Using a pessary: A pessary is a silicone device placed inside the vagina. It helps support the bulging tissues. You'll need to take the pessary out regularly to clean it. It's important to follow your doctor's instructions for cleaning and using the pessary.

• Surgery: If strengthening your pelvic floor muscles or using a pessary doesn't control your symptoms, or if other organs are also prolapsed, surgery might be needed. Surgery is also often an option if your prolapse is causing you significant discomfort or affecting your daily life.

During surgery, the surgeon will often remove extra, stretched tissue that is causing the bulge. They'll then use stitches to support the pelvic organs. If the uterus is also prolapsed, it might need to be removed (called a hysterectomy). Sometimes, surgery can repair multiple prolapses at the same time. This means the surgeon can address the issues with all the affected organs in one operation.

Taking care of yourself can help ease prolapse symptoms. Here are some simple things you can try:

• Strengthen your pelvic floor muscles: Kegel exercises are a great way to do this. These exercises work the muscles that support your pelvic organs, like your bladder, uterus, and bowel. If you have a vaginal prolapse, these exercises can help support the affected organs and reduce bulging sensations.

• Manage your bowel movements: Avoiding constipation is important. Eat plenty of high-fiber foods like fruits, vegetables, and whole grains. Drink plenty of water, and consider a fiber supplement if needed. Don't strain during bowel movements. Pushing too hard can make the prolapse worse.

• Avoid heavy lifting: Lifting heavy objects puts extra pressure on your pelvic floor muscles. Try to avoid this as much as possible.

• Control your coughs and sneezes: Coughing and sneezing can also put pressure on your pelvic floor. Try to control these when you can.

• Maintain a healthy weight: Being at a healthy weight can reduce the strain on your pelvic floor.

How to do Kegel exercises:

1. Find the right muscles: Imagine stopping your urine mid-stream. The muscles you use to do this are your pelvic floor muscles. Once you know where they are, you can practice the exercises. You can do them sitting, standing, or lying down. Lying down might be easier at first.

2. Practice the technique: Imagine you're lifting a small object (like a marble) with those muscles. Tighten your pelvic floor muscles for three seconds, then relax for three seconds. Repeat this several times.

3. Focus on the right muscles: Concentrate on only tightening the pelvic floor muscles. Don't tense your abdomen, thighs, or buttocks. Breathe normally throughout the exercise.

4. Consistency is key: Aim for at least three sets of 10 to 15 repetitions each day.

Getting professional help: Kegel exercises are often most effective when taught by a physical therapist or nurse practitioner. They can provide personalized guidance and, in some cases, biofeedback. Biofeedback uses special equipment to show you exactly how well you're contracting the right muscles. This can help you get the most out of your exercises.