About Posterior Vaginal Prolapse
Posterior vaginal prolapse, also known as rectocele, occurs when there is weakening of the muscles and tissues that support the pelvic organs, particularly the rectum and vaginal wall. This weakening can occur due to factors such as aging, pregnancy and childbirth, chronic constipation, chronic coughing or lung diseases that cause a lot of coughing. Non-modifiable risk factors are risk factors that cannot be changed. Non-modifiable risk factors of posterior vaginal prolapse include:
- Age: The risk of posterior vaginal prolapse increases with age.
- Race: Some studies suggest that white race may be a non-modifiable risk factor for posterior vaginal prolapse.
- Menopause: Women who have gone through menopause may be at higher risk.
Modifiable risk factors are risk factors that can be changed or influenced. Modifiable risk factors of posterior vaginal prolapse:
- Obesity or being overweight
- Giving birth vaginally, especially if it involves multiple births or prolonged labor
- Smoking
- Chronic constipation
- Occupations that involve heavy lifting
The symptoms of posterior vaginal prolapse can vary depending on the severity of the condition.
Early symptoms of posterior vaginal prolapse include:
- Pelvic heaviness or pulling
- Vaginal bleeding or an increase in vaginal discharge
- Difficulties with sexual intercourse
- Leakage of urine when coughing, sneezing, or laughing
- Inability to empty the bladder completely
- Frequent urination
- Bowel movement difficulties, such as constipation
- Lower back pain
- Weak vaginal tissue
As the prolapse progresses to later stages or higher severity, additional symptoms may occur. These include:
- Vaginal or vulvar irritation
- Aching discomfort in the pelvic area
- Painful sex
- Organs bulging out of the vaginal or urethral opening
- Bladder infections
To diagnose posterior vaginal prolapse, doctors commonly perform the following examinations, tests, and procedures:
- History and physical exam: A thorough history and physical exam including a pelvic exam will be performed. During a pelvic exam, your doctor will examine your pelvic organs, including the vagina and uterus. They may ask you to bear down or tighten and release your pelvic muscles to assess the strength of the muscles that support these organs.
- Cough test: Your doctor may perform a cough test during the physical examination. They will ask you to cough while they observe for any changes in the position of the vaginal wall.
In addition to the pelvic exam, there are additional examinations, tests, and procedures that can help determine the severity of posterior vaginal prolapse:
- Urodynamic testing: If you have problems with urination, your doctor may recommend urodynamic testing. This includes uroflowmetry, which measures the amount and strength of your urine stream, and cystometrogram, which determines how full your bladder needs to get before you feel the need to urinate.
- Bladder ultrasound: A bladder ultrasound is a non-invasive test that uses sound waves to check your bladder and other organs in the pelvis.
- Pelvic floor MRI: A pelvic floor MRI uses strong magnets and radio waves to create detailed images of your pelvic organs. This imaging test can help identify any structural abnormalities or damage.
- CT scan of abdomen and pelvis: A CT scan uses X-rays to create detailed pictures of your abdominal and pelvic organs. This imaging test can provide additional information about the condition of your pelvic organs.
The goals of treatment for posterior vaginal prolapse are to relieve symptoms and improve the quality of life for individuals experiencing this condition. Here is a breakdown of these treatment options and how they work to achieve the treatment goals:
Medications:
Your healthcare provider may prescribe medications to manage symptoms such as constipation or urinary incontinence that can be associated with this condition.
Therapies:
- Pelvic floor muscle exercises (Kegel exercises) are often recommended to strengthen the muscles that support the pelvic organs. These exercises involve contracting and relaxing the pelvic floor muscles to improve their tone and function. Physical therapy sessions with a specialized pelvic floor therapist may be recommended to guide individuals in performing these exercises correctly.
- Pessaries: Pessaries are devises that can help support the pelvic organs and prevent prolapse.
Therapeutic procedures:
- Surgical procedures are often considered for individuals with significant symptoms or when conservative treatments have not been effective.
- The choice of surgical procedure depends on the severity of the prolapse, specific symptoms, overall health, and patient preferences. Surgical treatments include posterior colporrhaphy, which involves repairing the weakened tissues in the posterior vaginal wall to restore support.
Self-care and health behavior changes:
- Maintaining a healthy weight
- Avoiding heavy lifting or straining during bowel movements
- Managing chronic conditions like constipation or chronic cough that can contribute to pelvic organ prolapse.
It's important to note that treatment decisions should be made in consultation with a healthcare provider who can assess individual circumstances and provide personalized recommendations based on the severity of the condition and individual needs.
Over time, posterior vaginal prolapse can progress and lead to various complications. In the early stages of posterior vaginal prolapse, you may not experience any symptoms or significant discomfort. As the condition progresses, you may start to notice a bulge or a feeling of heaviness in your vagina. With further progression, you may experience difficulties with bowel movements, such as constipation or incomplete emptying of the rectum. In severe cases, the bulging tissue may protrude out of the vagina.
Complications of posterior vaginal prolapse include:
- Difficulty passing stool: The bulging rectum can obstruct or hinder normal bowel movements, leading to symptoms like straining during bowel movements and a sensation of incomplete evacuation.
- Inability to control bowel movements or painful bowel movements
- Sexual discomfort
- Frequent urination or urinary tract infections
Remember to always consult with your doctor before trying any home remedies or over-the-counter medications for posterior vaginal prolapse. They will be able to provide appropriate guidance based on your individual circumstances.