Understanding Rectocele: A Guide to Posterior Vaginal Wall Prolapse

If you’ve recently received a rectocele diagnosis, or noticed symptoms that made you feel worried you could have one, it’s completely normal to feel blindsided (or even a little scared).  Most of us are taught a lot about puberty and pregnancy, but very little about the "middle" parts, like how your pelvic organs can shift over time, and how that can impact everything from how you feel in your own body, to your sexual function or even exercise.

The truth is, pelvic organ prolapse (POP) affects more than half of us at some point. But because we’ve been conditioned to keep pelvic health private, many people don't realize that rectum can prolapse until they’re already struggling with symptoms.

If you’re feeling a sense of heaviness, changes in your bowel function, or a feeling like you have a tampon falling out of your vagina, know that you’re not alone. A rectocele is common, manageable, and highly treatable. And it all starts with clear, practical information about what’s going on in your body, and the treatment options that are waiting for you.

What is a rectocele prolapse, anyway?

A rectocele is a type of pelvic organ prolapse that happens when your rectum drops down from its usual position, and presses forward into the backside of your vagina. 

Your vagina is sandwiched between your bladder (in the front) and your rectum (in the back). Normally, your rectum is supported by your pelvic floor muscles and strong connective tissues that keep everything in place. Between your rectum and vagina is a thin layer of tissue, known as the rectovaginal septum, which acts like a wall. 

When that wall weakens or stretches (from things like childbirth, aging, or chronic straining), the rectum can bulge forward into your vagina, creating a rectocele. This may cause a vaginal bulge that you can feel or see, along with symptoms that range from super mild to severe.

What are the rectocele symptoms?

A rectocele can cause a whole range of symptoms, which are usually a mix of pelvic pressure and bowel changes. In some cases, you may not have any symptoms at all. And the only sign you may have is a change seen during a pelvic exam or when looking with a mirror while bearing down.

When symptoms are present, they don’t always match how large your rectocele looks, and they don’t always get worse as your prolapse worsen, but they can.

Common rectocele symptoms include:

• A feeling of heaviness or like a tampon is falling out
• A dull ache in your lower back that kicks in by the end of the day
• Difficulty keeping a menstrual cup or disc in place
• Constipation or difficulties having a bowel movement
• A feeling like you can’t fully empty your bowels
• Stool leakage, or a feeling like you can’t ever get clean after pooping
• Pain during sex (dyspareunia)
• Sores or bleeding (this is a rare symptom, but sores and bleeding can happen if rectocele progresses to bulge outside of your vagina)

Some people notice tissue bulging at the back of their vaginal opening when bearing down, while others never see or feel any visible changes.

What causes rectocele?

There’s rarely one single cause of a rectocele. Instead, it’s usually caused by a variety of things that add up over time to weaken or damage your pelvic floor support. 

Here are some of the things that research says can increase your risk of developing a rectocele the most:

• Having a vaginal birth: Especially if forceps were needed to help in your birth
• Your age: Prolapse tends to be more common as you get older, because of things like more pressure over time, natural changes in muscle and tissue health as we get older, and hormone changes associated with menopause.
• Genetics: There are certain genes that have been found to be linked to the development of pelvic organ prolapse (POP)
• Chronic straining: From things like years of constipation or medical conditions like chronic obstructive pulmonary disease (COPD)

How do I know if I have a rectocele?

If you haven’t already been diagnosed, you can look to your body for clues to help you understand if you think you may have a rectocele. For example, symptoms like vaginal pressure or heaviness, or new or worsening bowel symptoms as noted above, could mean you may have a rectocele. 

You can also check yourself for signs of a pelvic organ prolapse (POP) at home. We have a helpful guide for how to do this safely, but here’s a quick overview:

• Grab a hand mirror and undress from the waste down.
• While standing, hold the mirror between your legs so you can see your vulva.
• Push hard, like you’re trying to have a bowel movement. 
• Look for any bulging near your vaginal entrance.

If you don’t know what a rectocele looks like, it may appear as a soft, fleshy bulge (similar to the inside of your cheek) coming from the back wall of your vagina. That said, these symptoms aren’t specific to rectocele. Vaginal pressure, bowel changes, or visible bulging can also be caused by other conditions. The best way to get a clear answer for your concerns is to see a healthcare provider for an exam. They can confirm what’s going on and help you create a plan to manage your symptoms.

What are the best treatments for rectocele?

Treating a rectocele isn’t just about “fixing” your anatomy. It’s about improving your symptoms and quality of life. And because symptoms don’t always match the size or grade of a prolapse, treatment should always be based on how you feel, not just what’s seen on an exam.

The best treatment for rectocele can depend on a whole variety of things, including the intensity of your symptoms, how significant your prolapse is, and your goals for treatment. 

Pelvic floor physical therapy

Pelvic floor physical therapy is usually the first line of treatment for a rectocele. And for good reason. It helps improve how your pelvic floor muscles function, whether that means strengthening or learning how to relax them.

Treatment may include coordination training between your core and pelvic floor, improving body mechanics, and learning how to better manage intra-abdominal pressure during daily activities and exercise. And if your muscles are tight, overworked, and painful, treatment may start with a focus on improving flexibility and control of your pelvic floor.

Bowel and bladder training

Because rectoceles are closely tied to your bowel function, optimizing your bathroom habits can make a big difference.

This might include improving stool consistency, reducing straining, and adjusting your toileting posture. The goal is to make bowel movements easier and reduce unnecessary pressure on the pelvic floor over time.

Pessary (pelvic floor support device)

A pessary is a removable device that’s inserted into your vagina to help support the vaginal walls and reduce symptoms of prolapse.

They come in many shapes and sizes and are usually fitted by a gynecologist or urogynecologist (and sometimes specially trained pelvic floor physical therapists). For many people, a pessary can provide a huge relief in symptoms without the need for surgery.

Lifestyle and movement modifications

Small, consistent changes in how you move and manage pressure in your body can have a big impact on your symptoms.

A big part of rectocele treatment usually includes education on things like: 

• Proper lifting techniques
• Avoiding chronic straining
• Managing conditions with persistent coughing
• Maintaining bowel regularity 

These strategies can be really helpful in reducing ongoing stress on your pelvic floor and supporting long-term symptom management.

External support options

External support garments or belts can also be helpful in certain situations. There are many different options to choose from, and each are designed to provide additional pelvic stability during higher-impact or physically demanding activities.

These can be a “temporary” form of support, especially during exercise or during longer days on your feet.

Surgery (rectocele repair)

If your symptoms aren’t improving with conservative treatment options, or if your symptoms are significantly affecting your quality of life, then surgery to repair your rectocele is another option.

The goal of rectocele surgery is to reinforce the tissue between your rectum and vagina, restoring support and reducing the bulge. There are several surgical approaches (including vaginal, abdominal, and rectal), and the best option depends on things like your individual anatomy, symptoms, and goals.

While surgery can be very helpful, it’s not one-size-fits-all. Preparing your body beforehand and continuing pelvic floor rehab afterward can be very important in your recovery and how you feel in the long term.

A whole-person approach

It’s also worth noting that prolapse symptoms aren’t always just about your muscles and organs. Similar to chronic pain conditions, rectocele symptoms can be influenced by how your nervous system processes pressure and sensation.

So sometimes, it can be important for treatment options for pain and calming and overactive nervous systems.

Fix your rectocele with Origin Physical Therapy

Rectoceles are common, but they’re also very treatable. And while it can be uncomfortable, you don’t have to live with symptoms or guess your way through healing your body. 

If you’re unsure where to start, we’re here to help. Our pelvic floor physical therapists are experts in all things rectocele. They can help you better understand your body, reduce symptoms, and get back to the activities you love. 

Schedule a session with a pelvic floor physical therapist to get a personalized plan and real relief.

Sources

Broekhuis, Suzan R., et al. "Perineal Descent and Patients' Symptoms of Anorectal Dysfunction, Pelvic Organ Prolapse, and Urinary Incontinence." International Urogynecology Journal, vol. 21, no. 6, Feb. 2010, pp. 721–29. PubMed Central, https://doi.org/10.1007/s00192-010-1099-z.

Brown, Heidi W., et al. "International Urogynecology Consultation Chapter 1 Committee 2: Epidemiology of Pelvic Organ Prolapse: Prevalence, Incidence, Natural History, and Service Needs." International Urogynecology Journal, vol. 33, no. 2, Feb. 2022, pp. 173–87. PubMed, https://doi.org/10.1007/s00192-021-05018-z.

Deprest, Jan A., et al. "International Urogynecological Consultation (IUC): Pathophysiology of Pelvic Organ Prolapse (POP)." International Urogynecology Journal, vol. 33, no. 7, July 2022, pp. 1699–710. PubMed, https://doi.org/10.1007/s00192-022-05081-0.

Ladd, Megan, and Faiz Tuma. "Rectocele." StatPearls, StatPearls Publishing, 8 Aug. 2023. NCBI Bookshelf, www.ncbi.nlm.nih.gov/books/NBK546689/.

Madhu, C., et al. "The Aetiology, Risk Factors and Management of Pelvic Organ Prolapse." The Obstetrician & Gynaecologist, vol. 24, no. 2, Apr. 2022, pp. 103–09. PubMed, https://doi.org/10.1111/tog.12799.