What is posterior vaginal prolapse (rectocele)? Symptoms, treatments, and exercises

It can feel awkward even to say the words “posterior vaginal prolapse,” let alone explain it. We get it — there’s no easy way to talk about your rectum or intestines shifting positions and pressing  into the vagina. While it can feel embarrassing, posterior vaginal prolapse is surprisingly common. Research shows that posterior vaginal prolapse, often known as rectocele, may occur in up to 80% of women. Another reassuring fact: the condition is treatable, often with at-home approaches like pelvic floor exercises, lifestyle changes, and devices like a pessary. 

Read on to learn what can cause posterior vaginal prolapse, common symptoms, and how pelvic floor physical therapy and lifestyle changes can help treat and prevent it — including with exercises from Hinge Health physical therapists.

What is posterior vaginal prolapse?

Posterior vaginal prolapse, or rectocele, is a type of pelvic organ prolapse that occurs when changes in your pelvic floor muscles and tissues make it harder to support your pelvic organs. This can allow pelvic organs to shift from their normal position.

The pelvic floor is a group of muscles, ligaments, and fascia (connective tissue) that stretches from your pubic bone in the front to your tailbone in the back. Like the foundation of a house, your pelvic floor helps support everything above it, including the rectum (the bottom of the colon), vagina, and the small intestine.

When the muscles and tissues of your pelvic floor — along with the wall of tissue that separates your rectum and vagina — become weaker or stretched, the rectum can bulge into the back wall of the vagina, creating a bulge. 

This is known as a rectocele, the most common form of posterior vaginal prolapse. Less commonly, the small intestine can push into the same area, causing a similar bulge, known as an enterocele. Both are sometimes grouped under the term posterior vaginal prolapse, as they affect the back (posterior) wall of the vagina.

There are also other types of pelvic organ prolapse that affect the front or top of the vagina, such as cystocele (when the bladder bulges into the front vaginal wall) and uterine prolapse (when the uterus drops down into the vagina).

Is posterior vaginal prolapse the same as hemorrhoids?

Posterior vaginal prolapse (rectocele) is not the same as hemorrhoids. While both may cause a feeling of pressure or a bulge in your vagina or pelvic area, hemorrhoids are swollen veins in the rectum or anus. Posterior vaginal prolapse (rectocele) involves the wall of the rectum bulging into the vagina.

“Learning you have posterior vaginal prolapse (rectocele) can feel scary, but it can help to understand that the pelvic organs themselves are not actually damaged,” notes Heidi Austin, PT, DPT, a pelvic health physical therapist at Hinge Health. “It’s simply that the tissue and structures supporting the positions of the vagina have gotten weak or injured. There are plenty of strategies that can help improve strength and support so you can manage symptoms and feel better.”

Causes of posterior vaginal prolapse

Posterior vaginal prolapse (rectocele) can happen when the muscles and tissues that support your pelvic organs become weak or stretched. When such changes happen to your pelvic floor muscles and tissues, the rectum and other organs may shift from their normal position and bulge into the vagina. 

Certain factors can raise your risk of developing posterior vaginal prolapse (rectocele), including: 

• Genetics. Some people are born with weaker connective tissue in the pelvic area, which makes them more likely to develop posterior vaginal prolapse.

• Pregnancy and childbirth. During pregnancy, the added weight of the baby, growing uterus, placenta, and amniotic fluid can put added stress on your pelvic floor, stretching the muscles and tissues that support the vagina. Vaginal childbirth can affect these supportive structures — especially after multiple deliveries or if you experience muscle tears during childbirth. 

• Aging and menopause. The pelvic floor can change as you age. Lower estrogen levels during and after menopause decrease muscle mass and weaken connective tissues, which can impact the vaginal wall and raise your risk of rectocele, says Dr. Austin.

• Obesity. Being overweight or obese, especially after menopause, significantly increases your risk of developing or worsening rectocele. Studies show that overweight and obese postmenopausal women are 37% and 58% more likely, respectively, than those with a normal body mass index to have rectoceles that worsen over time.

• Prolonged pressure on your abdomen. Chronic constipation, frequent heavy lifting with poor abdominal pressure management, or persistent coughing can put extra strain on your pelvic floor muscles and increase the risk of posterior vaginal prolapse.

Symptoms of posterior vaginal prolapse

Posterior vaginal prolapse (rectocele) often causes no symptoms. When symptoms do occur, they can include feelings of pressure or fullness, bowel changes, and discomfort during sex. Symptoms of posterior vaginal prolapse can include:

• Pressure or feeling of fullness in your vagina or rectum

• The sensation that something is falling out of your vagina 

• Constipation and difficult bowel movements

• Feeling unable to empty your rectum

• The urge to have a bowel movement several times a day

• Painful sex

People with a posterior vaginal prolapse (rectocele) may also have prolapse of the other pelvic organs, such as the bladder or uterus.

When to see a doctor

Posterior vaginal prolapse (rectocele) can often be managed with at-home or simple treatments. But if your posterior vaginal prolapse symptoms are severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It’s also a good idea to get care if you have:

• New or unexplained vaginal or rectal bleeding

• Severe pelvic or vaginal pain

• Inability to empty your bowel or bladder

• A bulge that is getting larger or more uncomfortable

• Trouble passing urine or stool

• Signs of infection (such as fever, chills, or unusual discharge)

These symptoms could be signs of a more serious issue or may mean your rectocele needs additional evaluation or treatment.

Pelvic floor physical therapy for posterior vaginal prolapse

Pelvic floor physical therapy is a key treatment for posterior vaginal prolapse (rectocele). Targeted exercises like Kegels strengthen the muscles that support your pelvic organs, which can help prevent or reduce symptoms of posterior vaginal prolapse.

“Pelvic floor physical therapy helps relieve symptoms and can help keep a prolapse from getting worse — it plays a key role in preventing progression,” says Dr. Austin.

A pelvic floor physical therapist (PT) can assess your needs to customize a strengthening and stretching program that’s right for you. They can also suggest ways to modify everyday activities to minimize posterior vaginal prolapse symptoms and empower you with tools and tips to help manage them. 

Recommendations may include using a vaginal pessary for added support, learning proper lifting and body mechanics to manage abdominal pressure and help keep prolapse from worsening, treating constipation with dietary changes and hydration, making bathroom posture adjustments, breathing techniques to reduce abdominal pressure, and incorporating core strengthening exercises to reduce the strain on the pelvic floor and improve how your body handles pressure and movement.

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit. Some exercises they may recommend can be found below.

These exercises can help you treat and manage symptoms of posterior vaginal prolapse (rectocele) by improving pelvic floor support, reducing discomfort, and promoting overall pelvic health. Diaphragmatic breathing eases pressure on the pelvic floor. Abdominal bracing helps your deep core and pelvic floor work together to reduce strain on the pelvic floor and better support your pelvic organs. Bridge coordinates core and pelvic floor muscles to manage pressure and limit prolapse symptoms. Wall groin stretch uses gravity to reduce pelvic floor strain and may ease rectocele discomfort from prolonged standing. Practicing these regularly can help manage symptoms of posterior vaginal prolapse.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

More ways to treat and prevent posterior vaginal prolapse

In addition to exercise and physical therapy, other options for treating and preventing posterior vaginal prolapse (rectocele) include using a vaginal pessary, making dietary changes, managing abdominal pressure, splinting techniques for easier bowel movements, and, in some cases, considering surgery. Here’s more about these options:

• Try a vaginal pessary. A vaginal pessary is a removable silicone device that you place inside your vagina. It helps support your muscles and tissues, holding your pelvic organs in place and relieving prolapse symptoms, explains Dr. Austin. Your doctor can fit you for a pessary, or you can purchase one over the counter at a drugstore or online.

• Make dietary changes. Fiber-rich foods (such as whole grains, fruits and veggies, and beans) and fluids can help ease constipation, which is a risk factor for posterior vaginal prolapse.

• Weight loss. If you are overweight or obese, your provider may recommend weight loss strategies to help keep symptoms from worsening.

• Manage abdominal pressure. Avoid straining during everyday tasks and lifts. Breathe out during the hard part—don’t hold your breath—and keep the load close to your body. For example, when lifting a suitcase into an overhead bin, exhale as you lift and hold it close to your chest; when pushing a heavy door or cart, breathe out as you push. If you have a chronic cough, get treatment to reduce repeated pressure.

• Try splinting for bowel movements. Splinting can help you empty more completely by gently supporting the rectum so stool passes more easily. With clean hands, press on the perineum (the area between the vagina and anus) from the outside using a clean finger or folded tissue, or gently insert a finger into the vagina to press on the back vaginal wall during a bowel movement. Splinting tools are also available for purchase.

• Consider surgery. If your posterior vaginal prolapse symptoms haven’t improved with other treatments — and they’re interfering with your daily life — you may be a candidate for surgery. Your healthcare provider can help decide whether rectocele repair is right for you and the best approach. The goal is to strengthen the support between your vagina and rectum to ease symptoms and improve daily comfort. You may need to see a specialist who treats prolapse, such as a urogynecologist, gynecologist, or urologist.

PT tip: Breathe to manage pressure

“Managing abdominal pressure is a key part of treating rectocele. Proper breathing techniques can help,” says Dr. Austin. When you're doing anything that increases pressure in your abdomen, like lifting something or having a bowel movement, try not to hold your breath or strain, she suggests. “Instead, exhale as you lift or push. This can help reduce pressure on your pelvic organs.”

How Hinge Health can help you

If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Kudish, B. I., Iglesia, C. B., Sokol, R. J., Cochrane, B., Richter, H. E., Larson, J., Hendrix, S. L., & Howard, B. V. (2009). Effect of Weight Change on Natural History of Pelvic Organ Prolapse. Obstetrics & Gynecology, 113(1), 81–88.doi:10.1097/aog.0b013e318190a0dd

3. Ladd, M., & Tuma, F. (2021). Rectocele. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK546689/

4. Mustain, W. (2016). Functional Disorders: Rectocele. Clinics in Colon and Rectal Surgery, 30(01), 063–075.doi:10.1055/s-0036-1593425

5. Rectocele Expanded Information | ASCRS. (n.d.). Fascrs.org. https://fascrs.org/patients/diseases-and-conditions/a-z/rectocele-expanded-information

6. Thorsen, A. J. (2023). Management of Rectocele with and without Obstructed Defecation. Seminars in Colon and Rectal Surgery, 34(1), 100937.doi:10.1016/j.scrs.2022.100937

7. Wallace, S. L., Miller, L. D., & Mishra, K. (2019). Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology, 31(6), 485–493. doi:10.1097/gco.0000000000000584