Posterior vaginal prolapse (rectocele)

Date Updated: 05/16/2026

Overview

A posterior vaginal prolapse is a type of pelvic organ prolapse. It happens when the tissue between the rectum and vagina weakens or tears. This can cause tissue from the rectum to push into the vagina, creating a bulge. Posterior vaginal prolapse also is called a rectocele (REK-toe-seel).

A rectocele can be caused by tears during childbirth, long-term straining with bowel movements and other activities that put pressure on pelvic tissues. A small rectocele might not cause symptoms.

A large rectocele can cause tissue to bulge through the vagina. To pass stool, you might need to support the vaginal wall with your fingers. This is called splinting. The bulge can be uncomfortable or cause you to feel like you can't completely empty your rectum during bowel movements. But it's rarely painful.

Treatment for posterior vaginal prolapse often is based on the person's symptoms and how much the symptoms affect daily life. Many people may benefit from self-care and other nonsurgical options. Some people with more severe posterior vaginal prolapse may have surgery.

Symptoms

A small posterior vaginal prolapse, also called a rectocele, might not cause symptoms.

Symptoms you may notice include:

A soft bulge of tissue in the vagina that might come through the opening of the vagina.
Trouble having a bowel movement.
Feeling pressure or fullness in the rectum.
Feeling as if the rectum isn't completely empty after a bowel movement.
Needing to support the vaginal wall with your fingers to pass stool. This is called splinting.

If you have posterior vaginal prolapse, you also may have prolapse of other pelvic organs, such as the bladder or uterus. During a pelvic exam, a healthcare professional can look at the prolapse and talk about ways to manage the symptoms.

When to see a doctor

Sometimes, posterior vaginal prolapse doesn't cause symptoms. But moderate or severe posterior vaginal prolapse might be uncomfortable. See a healthcare professional if your symptoms bother you or get worse.

Causes

Posterior vaginal prolapse, also called a rectocele, is caused when the tissue that separates your rectum and vagina weakens. This can happen for many reasons, including:

Vaginal childbirth. Childbirth can cause birth-related tears and put strain and pressure on the pelvic floor. Medical tools such as forceps that are used during birth also may damage pelvic floor muscles and supporting tissues.
Long-lasting straining. Straining to have a bowel movement can weaken pelvic floor tissues over time.
Increased pelvic floor pressure. Anything that puts pressure on the pelvic floor for a long time may cause a rectocele. This may include a long-lasting cough or bronchitis, being overweight, or heavy lifting.

Pregnancy and childbirth

Many of the muscles, ligaments and tissues that support the vagina are stretched during pregnancy, labor and delivery. This can make those tissues weaker and less supportive. The more pregnancies you have, the more likely you are to have posterior vaginal prolapse.

You're less likely to have posterior vaginal prolapse if you've had only cesarean deliveries. But you still could develop the condition.

Risk factors

Posterior vaginal prolapse, also called a rectocele, can happen to anyone who has a vagina. However, some things may increase risk, such as:

Genetics. Some people are born with weaker connective tissues in the pelvic area. This makes them more likely to develop posterior vaginal prolapse.
Vaginal childbirth. Having several vaginal births can increase the risk of posterior vaginal prolapse. If you had tearing or needed a small cut — called an episiotomy — to help with delivery, that also can increase the risk. Also, the use of tools such as forceps to help with delivery is linked to a higher chance of posterior vaginal prolapse.
Aging. Pelvic floor issues such as a rectocele are more common with age. That's because growing older causes the loss of muscle mass, elasticity and nerve function. This can cause muscles to stretch or weaken.
Menopause. Women who have gone through menopause are more likely to have posterior vaginal prolapse. Hormone changes that happen during menopause can weaken connective tissues in the pelvic area.
Overweight and obesity. Extra body weight places stress on pelvic floor tissues and increases the risk of posterior vaginal prolapse.

Prevention

Posterior vaginal prolapse, also called a rectocele, can't always be prevented. But you can try some things to keep it from getting worse:

Do Kegel exercises regularly. These exercises can strengthen pelvic floor muscles, which support the bladder, rectum and uterus.
Treat and prevent constipation. Drink plenty of fluids and eat high-fiber foods, such as fruits, vegetables, beans and whole-grain cereals. Fiber helps prevent constipation and straining, which may reduce the risk of a rectocele.
Avoid heavy lifting and lift correctly. Use your legs instead of your waist or back to lift.
Control coughing. Get treatment for a chronic cough or bronchitis.
Maintain a healthy weight. Ask your healthcare professional about the best weight for you. Ask for help losing weight, if needed.
Quit smoking. Smoking may cause a long-term cough, which can stress pelvic floor muscles. Talk to your healthcare professional if you need help quitting smoking.

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.

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 an 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?