Uterine Prolapse and Pelvic Relaxation (Rectocele) 

Uterine prolapse is just what it sounds like—the uterus drops down into the vagina, and in severe cases, outside the vagina. It occurs from injury to the fascia, which is the tissue that supports and holds up the uterus. Weakening of the ligaments that support the uterus and loss of pelvic floor musculature also contribute to the loss of the normal uterine position.

Women who have uterine prolapse frequently have other organs that are displaced due to weak pelvic tissues. A cystocele results when a prolapsed bladder bulges through the vaginal roof; a rectocele occurs when the rectum bulges through the vaginal floor.

Who gets a Rectocele?

Vaginal deliveries, particularly if the labor is long and the baby large, are the greatest risk factor for pelvic relaxation. It is not the only risk factor, since most women who deliver vaginally do not end up with problems. Family history seems to be a major factor. Tissue that is prone to damage is an inherited tendency, and it is not unusual for a woman to mention that her mother and grandmother had the same problem. Take a genetic predisposition, add a nine-pound baby and three hours of pushing... something is going to give. Once the tissue is damaged, it never completely regains its strength and elasticity; the effects of gravity and age then compound the problem.

Smoking is also a major risk factor. Smokers have poor tissue in general, and chronic coughing weakens tissue even further. Long-distance runners may also have a greater propensity for prolapse. The running probably doesn’t cause the weakened tissue; it just makes an already tenuous situation worse from the constant pounding.


How do you know if you have a rectocele?

Symptoms are generally related to the degree of the rectocele.  In a mild rectocele, the rectum slightly bulges through the floor of the vagina, and most women are totally unaware that something has shifted unless their gynecologist points it out. 

If the rectocele is more severe, there is often vaginal pressure. Some women actually feel a mass or bulge at the vaginal opening. A quick look in the mirror (a hand mirror with a long handle works really well) and you can see something pink bulging out. Low back pain and discomfort during intercourse are common.  In severe cases, there may be an inability to have a bowel movement without using fingers to press on the floor of the vagina. 


Treatment Options

A rectocele can be repaired as an outpatient procedure and is performed vaginally by reconstructing the floor of the vagina.  Rectocele surgery is often performed in conjunction with other corrective procedures in the case of a cystocele or uterine prolapse.


Non-Surgical Treatment of Cystocele 
Non-surgical options are available and useful if the condition is not severe, or if a woman is a poor surgical candidate. Some women simply want to avoid surgery or need to delay surgery until a more convenient time.


Vaginal tissues and supporting structures depend on estrogen for strength and elasticity. Women in low estrogen states (menopause, breastfeeding moms) often are the most symptomatic. The use of estrogen in the form of vaginal rings, tablets or vaginal creams will often improve a mild rectocele such that no other treatment is needed. Severe rectoceles, third- or fourth-degree, will rarely respond to estrogen therapy alone but can be useful as an adjunct to other therapy.

Menopausal women who are scheduled for surgery will have a better result if they are pretreated with estrogen for at least a few weeks before surgery. The tissue is much easier to work with and will be more supportive. Often, gynecologists will recommend continuing the use of vaginal estrogen creams after surgery to maintain surgical results, particularly if the vaginal tissues are dry and thin.

Exercises/Pelvic Physical Therapy

We work closely with experienced pelvic physical therapists to strengthen the pelvic floor and alleviate symptoms.