Posterior vaginal prolapse (rectocele)

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. Your healthcare professional may be able to see the size and location of the prolapse.
• Tightening pelvic muscles as if stopping a stream of urine. This test checks the strength of the pelvic muscles.

In order to know how severe the prolapse is, your healthcare professional may take specific measurements during the pelvic exam. This shows how far the pelvic organs have lowered. Your healthcare professional may use this information to help plan your treatment.

Rarely, you might need an imaging test:

• MRI or an X-ray can be used to see what organs are affected and to get a detailed view of the vagina and rectum.
• Defecography is a test to check how well your rectum empties when you have a bowel movement. During the test, a contrast dye is used with an imaging test, such as X-ray or MRI.

Treatment

Treatment for posterior vaginal prolapse, also called a rectocele, depends on how severe the condition is and how much your symptoms bother you. If you don't have symptoms, you may not need treatment. If you do have symptoms, nonsurgical treatments may help. Nonsurgical treatments might involve:

• Pelvic floor exercises. If the posterior vaginal prolapse causes few or no symptoms, strengthening the pelvic muscles by doing Kegel exercises might give relief.
• Pessary. A vaginal pessary is a disc-shaped silicone device that fits in the vagina. It helps support the pelvic organs. A pessary must be taken out and cleaned regularly.

Surgery

Surgery for posterior vaginal prolapse, also called a rectocele, might be needed if:

• Nonsurgical treatments don't help your symptoms.
• Your symptoms bother you and affect your daily life to the point that you want surgery.

Surgery often involves removing the extra tissue that forms the vaginal bulge. The surgeon uses stitches to support pelvic muscles and tissues between your vagina and rectum. If the bladder or uterus also is prolapsed, that can be repaired as well. More than one type of prolapse can be repaired during the same surgery.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Sometimes, self-care can help with prolapse symptoms. You can:

• Do Kegel exercises to strengthen pelvic muscles.
• Eat high-fiber foods, drink plenty of fluids and, if needed, take a fiber supplement to help with constipation.
• Try not to strain during bowel movements.
• Avoid heavy lifting.
• Control coughing.
• Keep a healthy weight.
• Quit smoking.

Kegel exercises

Kegel exercises strengthen pelvic floor muscles. A strong pelvic floor provides better support for pelvic organs. It also might relieve some symptoms of posterior vaginal prolapse.

To perform Kegel exercises:

• Find the right muscles. To find your pelvic floor muscles, try stopping urine midstream. Once you know where these muscles are, you can practice these exercises. You can do the exercises lying down, sitting or standing.
• Perfect your technique. To do Kegels, imagine you are sitting on a marble and tighten your pelvic muscles as if you're lifting the marble. Try it for three seconds at a time, then relax for a count of three.
• Maintain your focus. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your stomach, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.
• Repeat three times a day. Aim for at least three sets of 10 to 15 repetitions a day. Try to do the exercises sitting, lying down and standing. This helps make the muscles strong.

Kegel exercises work best when they're taught by a healthcare professional and supported with biofeedback. Biofeedback uses monitoring devices to let you know that you're tightening the right muscles the right way.

Preparing for your appointment

For posterior vaginal prolapse, also called a rectocele, you might need to see a doctor who specializes in female pelvic floor conditions. This type of doctor is called a urogynecologist.

Here are some tips to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms and when they started.
• All medicines, vitamins and supplements you take, including the doses.
• Key personal and health information, including other conditions, recent life changes and stressors.
• Questions to ask your healthcare professional.

For posterior vaginal prolapse, some basic questions to ask your healthcare professional are:

• What can I do at home to ease my symptoms?
• Are there any activities I should avoid?
• Will the bulge grow if I don't get treatment?
• Which treatment do you recommend?
• How likely is it that my condition will come back after surgery?
• What are the risks of surgery?

Be sure to ask any other questions that you may think of during your appointment.

What to expect from your healthcare professional

Your healthcare professional may ask you a number of questions, such as:

• Do you have pelvic pain?
• Do you ever leak urine?
• Have you had a severe or ongoing cough?
• Do you do any heavy lifting in your job or daily activities?
• Do you strain during bowel movements?
• Has anyone in your family ever had pelvic organ prolapse or other pelvic conditions?
• How many children do you have? How many were vaginal births?
• Do you plan on having children in the future?