What Is Posterior Vaginal Prolapse?
Posterior vaginal prolapse, also called rectocele, occurs when the thin wall of the tissue that separates the vagina from the rectum weakens and bulges into the vaginal wall.
What Are the Symptoms of Posterior Vaginal Prolapse?
Rectoceles usually do not always cause symptoms. But when the symptoms occur, they are usually more uncomfortable or unpleasant than painful.
Signs and symptoms of a posterior vaginal include:
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Feeling of pressure or fullness in the rectum or vagina.
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A tissue bulge that may or may not bulge through the vagina.
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Feeling discomfort during intercourse.
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Having the urge to poop several times a day.
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Sensing a feeling of loss of muscle tone in the vagina.
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Feeling that the rectum has not completely emptied after a bowel movement.
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Having to press the fingers on the bulge in the vagina to push out a stool during a bowel movement (splinting).
Many women with posterior vaginal prolapse can also experience prolapse of other pelvic organs, such as the uterus and bladder. So, women may also have the feeling of frequent urination.
What Are the Causes of Posterior Vaginal Prolapse?
A posterior vaginal prolapse occurs when the pelvic floor muscles weaken. Several factors can contribute:
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Aging - The pelvic floor can weaken in older women. Menopause can cause many changes in the body, which leads to decreased muscle tone in the pelvic region.
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Pregnancy and Childbirth - Vaginal childbirth, especially complicated pregnancy, and multiple births, can damage or weaken the pelvic floor muscles. Prolonged labor and a large baby can stretch the pelvic floor muscles, leading to weakened support for the vagina.
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Heavy Lifting - A job that involves frequent weight lifting can place too much strain on the pelvic floor muscles, causing them to stretch and weaken.
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Chronic Constipation - Straining too hard to empty the bowel can weaken the pelvic muscles over time.
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Chronic Cough - Prolonged coughing associated with smoking, asthma, and respiratory disease can also strain the pelvic floor over time.
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Being Overweight or Obese - Having obesity can increase the risk of rectocele.
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Previous Surgery - Surgeries involving the pelvic organs like hysterectomy can damage the tissue of the pelvic floor muscle.
How Is Posterior Vaginal Prolapse Diagnosed?
During the diagnosis of posterior vaginal prolapse, a pelvic examination of the vagina and rectum is done.
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Pelvic Examination - During the pelvic exam, the doctor may ask the patient to do the following:
- To apply pressure to the gut or strain like having a bowel movement which causes the posterior vaginal prolapse to bulge, so the doctor can assess the size and location of posterior vaginal prolapse.
- Also, asks the patient to tighten the pelvic muscles as if stopping a stream of urine. This test checks the strength of the pelvic muscles.
- The doctor may also ask questions about the extent of the bulge in the vagina and how much it affects the quality of life. This information may help in treatment planning.
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Imaging - Imaging is not often used for rectocele diagnosis. In rare instances, the doctor might ask for a transvaginal ultrasound to check if the small intestine has prolapsed. The doctors may ask for a special X-ray called a defecography. A defecography shows the changes in the rectum when emptying the bowel. It can show the severity of a rectocele.
What Is the Treatment for Posterior Vaginal Prolapse?
Mild rectoceles may be treated with pelvic floor exercises to strengthen the pelvic floor muscles. The doctors may also recommend a pessary. A vaginal pessary is a plastic or rubber ring, a removable device inserted into the vagina to support prolapsed organs. The vaginal pessary should be removed periodically for cleaning.
Surgery for Rectocele -
Surgery may be needed if the rectocele does not respond to other treatments and is causing discomfort for the patient. Depending on the factors, like the severity of the rectocele and the presence of other pelvic organ prolapses, the surgery may be performed in different approaches, which include, the vaginal approach, anus approach, abdominal approach, and perineum approach (the area between the vagina and anus). In some rare cases, a combination of two approaches is used. The goal of the surgery is to repair and strengthen the wall between the rectum and vagina. The procedure for the rectum repair includes:
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One or more cuts are made along the back wall of the vagina to reveal the underlying structures.
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The pelvic floor muscles which are weakened around the vagina and rectum, are repaired and strengthened with absorbable stitches.
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A mesh patch might be inserted to strengthen and support the fascia.
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The wall of the vagina is also repaired using absorbable stitches.
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In some cases, the area between the vagina and anus needs to be repaired at the same time, with deep stitches in the muscle.
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In some cases, where the stretching of the vagina has occurred, in such instances, the excess tissues are removed.
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The incisions are stitched closed.
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The vagina is packed with gauze.
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A urinary catheter is inserted to drain the urine from the bladder.
What Are the Complications of Surgery for Rectocele?
Possible complications of surgery include:
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Allergic reaction to the anesthetic.
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Damage to other pelvic organs, such as the bladder or rectum.
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Infection.
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Hemorrhage.
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Injury to nearby blood vessels or nerves.
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Necrosis (death) of the rectal wall.
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Recurrence of the rectal prolapse.
How to Prevent Rectocele?
The rectocele or pelvic organ prolapse can not be prevented. Still, by following good practices into place, the pelvic floor muscles can be strengthened. Following are the few strategies used to manage mild cases of rectocele that can be used to reduce the risk of prolapse.
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Perform Kegel Exercise Regularly - Kegel's exercise can strengthen the pelvic floor muscles. Ask the healthcare provider about when it is safe to perform Kegel's exercise after the baby's birth.
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Prevent Constipation - Drink more water and eat high-fiber foods, such as fruits, vegetables, nuts, and whole-grain cereals. Try to eat 25 to 35 grams of fiber every day and eight glasses of water. Consume stool softeners if required.
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Avoid Heavy Lifting - When lifting heavy objects, use the legs instead of the waist or back. Get someone's help when lifting heavier objects.
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Treat a Cough - Consult a doctor for a chronic cough or bronchitis and avoid smoking.
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Maintain a Healthy Weight - Talk with the doctor to determine the ideal weight and get advice on weight-loss strategies if you need them.
Conclusion -
The posterior vaginal prolapse can be embarrassing and uncomfortable and make it difficult to empty bowel movements. In mild cases, it can be prevented with Kegel’s exercise, controlling constipation and obesity. In severe cases, surgery is recommended.
