Diagnosis

A diagnosis of posterior vaginal prolapse generally occurs during a pelvic exam of your vagina and rectum.

During the pelvic exam your doctor is likely to ask you:

  • To bear down as if having a bowel movement. Bearing down may cause the posterior vaginal prolapse to bulge, so your doctor can assess its size and location.
  • To tighten your pelvic muscles as if you're stopping a stream of urine. This test checks the strength of your pelvic muscles.

You might fill out a questionnaire that helps your doctor assess how far the bulge extends into your vagina and how much it affects your quality of life. This information helps guide treatment decisions.

Rarely, your doctor might recommend imaging tests:

  • MRI or an X-ray can determine the size of the tissue bulge
  • Defecography can determine how efficiently your rectum empties

Treatment

Treatment depends on the severity of the posterior vaginal prolapse. Your doctor might recommend:

  • Observation. If your posterior vaginal prolapse causes few or no symptoms, simple self-care measures — such as performing Kegel exercises to strengthen your pelvic muscles — may provide relief.
  • Pessary. A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bulging tissues. A pessary must be removed regularly for cleaning.

Surgery

Surgical repair might be needed if:

  • The posterior vaginal prolapse protrudes outside your vagina and is especially bothersome.
  • You have prolapse of other pelvic organs in addition to posterior vaginal prolapse that is bothersome. Surgical repair for each condition can be completed at the same time.

The surgery uses a vaginal approach and usually consists of removing excess, stretched tissue that forms the posterior vaginal prolapse. A mesh patch might be inserted to support and strengthen the fascia.

Lifestyle and home remedies

Depending on the severity of your posterior vaginal prolapse, self-care measures may provide relief. Try to:

  • Perform Kegel exercises to strengthen pelvic muscles and support the weakened fascia
  • Avoid constipation by eating high-fiber foods and drinking plenty of fluids
  • Avoid bearing down to move your bowels
  • Avoid heavy lifting
  • Control coughing
  • Lose weight if you're overweight or obese

Kegel exercises

Kegel exercises strengthen your pelvic floor muscles. A strong pelvic floor provides better support for your pelvic organs, prevents prolapse from worsening and relieves symptoms associated with posterior vaginal prolapse.

To perform Kegel exercises:

  • Tighten (contract) your pelvic floor muscles as though you were trying to prevent passing gas.
  • Hold the contraction for five seconds, then relax for 10 seconds. If this is too difficult, start by holding for two seconds and relaxing for five seconds.
  • Work up to holding the contractions for 10 seconds at a time.
  • Aim for at least three sets of 10 repetitions each day.

Kegel exercises may be most successful when they're taught by a physical therapist and reinforced with biofeedback. Biofeedback involves using monitoring devices that help ensure you're tightening the muscles properly for the best length of time.

Once you've learned the proper method, you can do Kegel exercises discreetly just about anytime, whether you're sitting at your desk or relaxing on the couch.

Preparing for your appointment

You may be referred to a gynecologist.

Here's some information to help you get ready for your appointment.

What you can do

  • List symptoms you've been having, and for how long.
  • List all medications, vitamins and supplements you take, including the doses.
  • List key personal and medical information, including other conditions, recent life changes and stressors.
  • Prepare questions to ask your doctor.

For posterior vaginal prolapse, some basic questions to ask your doctor include:

  • What can I do at home to ease my symptoms?
  • Should I restrict any activities?
  • What are the chances that the bulge will grow if I don't do anything?
  • What treatment approach do you recommend?
  • What's the likelihood that the posterior vaginal prolapse will recur if I have it surgically treated?
  • What are the risks of surgery?

During your appointment, don't hesitate to ask other questions as they occur to you.

What to expect from your health care provider

Your doctor is likely to ask you a number of questions, including:

  • What symptoms are you experiencing?
  • When did you first notice your symptoms? Have they worsened over time?
  • 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 posterior vaginal prolapse or any other pelvic problems?
  • How many children have you given birth to? Were your deliveries vaginal?
  • Do you plan to have children in the future?