Symptoms and causes

Symptoms

A small posterior vaginal prolapse (rectocele) may cause no signs or symptoms.

Otherwise, you may notice:

  • A soft bulge of tissue in your vagina that might protrude through the vaginal opening
  • Difficulty having a bowel movement
  • 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 vaginal prolapse also experience prolapse of other pelvic organs, such as the bladder, uterus or — for women who have had surgery to remove the uterus (hysterectomy) — the top of the vagina.

When to see a doctor

Posterior vaginal prolapse is common, even in women who haven't had children. In fact, you may not even know you have posterior vaginal prolapse.

But sometimes moderate or severe posterior vaginal prolapses can be bothersome or uncomfortable. See your doctor if:

  • You have a bothersome bulge of tissue that protrudes through your vaginal opening
  • Constipation treatment isn't successful at producing soft and easy-to-pass stool between three times a day to three times a week

Causes

Posterior vaginal prolapse results from pressure on the pelvic floor. Causes of increased pelvic floor pressure include:

  • Chronic constipation or straining with bowel movements
  • Chronic cough or bronchitis
  • Repeated heavy lifting
  • Being overweight or obese

Pregnancy and childbirth

The muscles, ligaments and connective tissue that support your vagina become stretched and weakened during pregnancy, labor and delivery. The more pregnancies you have, the greater your chance of developing posterior vaginal prolapse.

Women who have had only cesarean deliveries are less likely to develop posterior vaginal prolapse, but still may.

Risk factors

Factors that may increase your risk of posterior vaginal prolapse include:

  • Genetics. Some women are born with weaker connective tissues in the pelvic area, making them naturally more likely to develop posterior vaginal prolapse.
  • Childbirth. If you have vaginally delivered multiple children, you have a higher risk of developing posterior vaginal prolapse. If you've had tears in the tissue between the vaginal opening and anus (perineal tears) or incisions that extend the opening of the vagina (episiotomies) during childbirth, you may also be at higher risk.
  • Aging. As you grow older, you naturally lose muscle mass, elasticity and nerve function, causing muscles to stretch or weaken.
  • Obesity. Extra body weight places stress on pelvic floor tissues.