Rectocele: Understanding and Treating Posterior Vaginal Wall Prolapse

Overview

A rectocele occurs when the tissue wall separating the rectum and vagina becomes weakened or stretched, causing the rectum to bulge into the vaginal space. This condition, also known as posterior vaginal wall prolapse, represents one of the most common forms of pelvic organ prolapse and can significantly impact bowel function, comfort, and quality of life.

This pelvic health condition affects a substantial portion of the population, with research indicating that approximately 40% of people with vaginas over age 50 experience some degree of rectocele. However, many individuals develop symptoms earlier in life, and the condition can occur across diverse age groups and backgrounds. While rectoceles are more frequently diagnosed in individuals who have given birth vaginally or are postmenopausal, they can also affect people who have never been pregnant, younger adults, and those from various gender identities and sexual orientations.

The impact of rectocele extends beyond physical symptoms, often affecting intimate relationships, daily activities, and overall well-being. Many people experience feelings of embarrassment or isolation when dealing with bowel dysfunction or pelvic pressure, but it's important to understand that rectoceles are common medical conditions with effective treatment options available.

Pelvic floor physical therapy offers a proven, non-surgical approach to managing rectocele symptoms and improving pelvic health. Through specialized techniques, targeted exercises, and comprehensive education, pelvic floor physical therapy can help restore function, reduce discomfort, and enhance quality of life. Many individuals find significant symptom relief and prevent further progression of their condition through dedicated pelvic health treatment, making it an essential first-line intervention for rectocele management.

Symptoms

Rectocele symptoms can vary widely based on the size of the prolapse, individual anatomy, and daily activities. Understanding these symptoms can help you recognize when to seek pelvic health care:

Bowel-Related Symptoms:

• Difficulty completely emptying the bowels, creating a sensation that stool remains trapped
• Need to apply manual pressure to the vaginal wall, perineum, or buttocks to facilitate bowel movements
• Incomplete evacuation feeling after bowel movements
• Chronic constipation or increased straining during bowel movements
• Changes in bowel movement frequency or consistency
• Feeling of obstruction during defecation

Physical Sensations:

• Persistent feeling of vaginal pressure, heaviness, or fullness
• Noticeable bulge or protrusion in the vagina that may be visible or felt during daily activities
• Pressure that worsens with prolonged standing, walking, or physical exertion
• Lower back pain that intensifies throughout the day
• Pelvic discomfort that improves when lying down
• Sensation of "something falling out" during exercise or coughing

Impact on Daily Life:

• Discomfort or pain during intimate activities or penetration
• Difficulty with tampon insertion or retention
• Reduced exercise tolerance due to pelvic pressure
• Disrupted sleep patterns due to discomfort
• Anxiety or embarrassment about bowel function
• Social limitations due to unpredictable symptoms

Causes

Rectoceles develop when the supportive tissues of the pelvic floor become weakened or damaged. Multiple factors often contribute to this condition, and understanding these causes can help guide treatment and prevention strategies:

Pregnancy and Childbirth Factors: Vaginal delivery, particularly with prolonged labor, large babies, or multiple births, can stretch and weaken the tissue between the rectum and vagina. The physical stress of pregnancy itself, including increased abdominal pressure and hormonal changes affecting tissue elasticity, can contribute to pelvic floor weakening even before delivery occurs.

Chronic Physical Stresses: Repeated straining from chronic constipation places significant pressure on pelvic floor tissues over time. Other contributors include chronic coughing from respiratory conditions, frequent heavy lifting (whether occupational or recreational), and high-impact exercises performed without proper pelvic floor support.

Hormonal and Age-Related Changes: Menopause brings decreased estrogen levels, which directly affects the strength and elasticity of pelvic floor tissues. Natural aging processes also contribute to gradual weakening of connective tissues throughout the body, including those supporting pelvic organs.

Genetic and Constitutional Factors: Some individuals have naturally weaker connective tissue due to genetic factors, making them more susceptible to developing rectoceles. Conditions affecting connective tissue strength, such as Ehlers-Danlos syndrome, can increase prolapse risk.

Lifestyle and Environmental Contributors: Obesity increases intra-abdominal pressure and stress on pelvic floor structures. Poor posture, particularly prolonged sitting or standing with inadequate core support, can contribute to pelvic floor dysfunction. Limited physical activity can lead to overall muscle weakness, including pelvic floor muscles.

Medical and Surgical History: Previous pelvic surgeries, including hysterectomy or rectocele repair, can alter normal anatomical support. Neurological conditions affecting muscle control and sensation can impact pelvic floor function and contribute to prolapse development.

How Pelvic Floor Physical Therapy Can Help

Pelvic floor physical therapy provides comprehensive, evidence-based treatment for rectocele that addresses both symptoms and underlying contributing factors. This specialized form of physical therapy offers a conservative yet highly effective approach to managing pelvic organ prolapse and improving overall pelvic health.

Targeted Muscle Strengthening and Coordination: Your pelvic floor physical therapist will design a personalized exercise program to strengthen weakened pelvic floor muscles while improving coordination between different muscle groups. This includes teaching proper contraction techniques, timing of muscle activation, and integration with breathing patterns and daily movements. Strengthening the deep core muscles, including the diaphragm, pelvic floor, and deep abdominal muscles, creates better support for pelvic organs and reduces prolapse symptoms.

Manual Therapy Techniques: Specialized hands-on techniques can address muscle tension, fascial restrictions, and trigger points that may contribute to pelvic floor dysfunction. Manual therapy can improve tissue mobility, reduce pain, and enhance muscle function, creating an optimal environment for healing and recovery.

Bowel Health Optimization: Education about proper toileting postures, breathing techniques during bowel movements, and dietary modifications can significantly improve bowel function and reduce straining. Your therapist will teach specific techniques for efficient evacuation and provide strategies for managing constipation naturally.

Functional Movement Training: Learning proper body mechanics for daily activities helps protect the pelvic floor from excessive strain. This includes techniques for lifting, exercise modifications, and posture correction that supports optimal pelvic health throughout daily life.

Pain Management and Symptom Relief: Various techniques including biofeedback, relaxation training, and gentle stretching can help manage discomfort and improve overall comfort levels. Your therapist will teach self-management strategies you can use at home to maintain progress between sessions.

Education and Empowerment: Understanding your condition, treatment options, and self-care strategies empowers you to take an active role in your recovery. Education about anatomy, normal function, and lifestyle modifications provides the foundation for long-term pelvic health management.

At Mendwell Pelvic Health, our experienced pelvic floor physical therapists provide individualized care that addresses your specific symptoms, goals, and lifestyle needs. We combine the latest evidence-based techniques with compassionate, patient-centered care to help you achieve optimal pelvic health and improved quality of life.

Frequently Asked Questions

How effective is pelvic floor physical therapy for treating rectocele symptoms?‍

Pelvic floor physical therapy has shown excellent results for managing rectocele symptoms, with many patients experiencing significant improvement in bowel function, pelvic pressure, and overall quality of life. While individual results vary, research consistently demonstrates that conservative treatment through specialized physical therapy can effectively manage symptoms and may help avoid or delay surgical intervention for many people with rectoceles.

‍What can I expect during my first pelvic floor physical therapy appointment for rectocele?

Your initial evaluation will include a comprehensive discussion of your symptoms, medical history, and goals for treatment. Your therapist will perform appropriate physical assessments, which may include evaluation of posture, breathing patterns, and pelvic floor muscle function. Based on this assessment, your therapist will develop a personalized treatment plan and begin teaching you techniques you can start using immediately to improve your symptoms.

How long does rectocele treatment with pelvic floor physical therapy typically take?

Treatment duration varies based on individual factors including symptom severity, overall health, and consistency with home exercises. Many patients begin noticing improvements within 6-8 weeks of starting treatment, with continued progress over several months. Your therapist will regularly assess your progress and adjust your treatment plan to ensure optimal outcomes.

Can I exercise and stay active with a rectocele?

Yes, staying active is beneficial for overall pelvic health when done appropriately. Your pelvic floor physical therapist will help you modify exercises and activities to protect your pelvic floor while maintaining fitness and strength. They will teach you specific techniques for safe exercise and help you gradually return to activities you enjoy while managing your symptoms effectively.

Will my rectocele get worse without treatment?

While not all rectoceles progress, many can worsen over time without appropriate management. Early intervention with pelvic floor physical therapy can help prevent symptom progression and provide you with tools to maintain pelvic health long-term. Even if surgical intervention becomes necessary in the future, pre-operative pelvic floor physical therapy can improve surgical outcomes and recovery.

Is pelvic floor physical therapy covered by insurance for rectocele treatment?

Most insurance plans cover pelvic floor physical therapy when medically necessary for treating conditions like rectocele. Our team at Mendwell Pelvic Health can help verify your insurance benefits and work with you to understand your coverage options for treatment.