Everything You Wanted To Know About Rectoceles (Or Posterior Vaginal Prolapse)

At the six-week checkup after my second baby’s birth, my midwife was inspecting my lady parts when she cheerfully announced that I was the proud owner of something called a rectocele. She could tell that I had no idea what she was talking about, so she explained it as simply and frankly as possible.

“It’s where your rectum gets pushed right against your vaginal wall. You’ll feel it particularly anytime you’re constipated.”

Oh, swell! That’s exactly what I needed in my life.

My midwife went on to explain that my rectocele was pretty minor, and that it probably happened as a result of the birth (pushing out my second baby was a shitshow), and that strengthening my pelvic floor would help move my rectum into a more acceptable position. Umm…okay?

Honestly, I didn’t think much about the whole thing for a few years, thanks to the exhausting, all-consuming job of raising little ones. Mostly, I was just glad that it wasn’t something too serious that would impact my life in any significant way. I did my Kegels (when I remembered) and mostly just kept my fingers crossed that nothing worse would come of it.

But now, a few years later as I’m nearing the big 4-0, it seems like everything down there is sinking farther down and that damn rectocele is starting to bother me more. I’ll spare you the gory personal details, but let’s just say that it sometimes feels like my butt is living inside my vagina (don’t worry: it’s not literally!), and that is not good for anyone.

I recently decided I better learn everything I can about rectoceles and find out if there is anything I can do about fixing mine, or at least lessening some of the shitty symptoms (pun definitely intended). In doing my research, I found out that a whopping 40% of women have rectoceles, though the intensity of them varies widely.

So, considering so many of us have ill-positioned rectums, I will be generous and share everything you never ever wanted to know about recotceles.

First of all, you’re probably saying, “What do you mean 40% of women have rectoceles? I’ve never even heard of them!” Well, according to the American Society of Colon and Rectal Surgeons, part of the reason for that is that most women who have rectoceles don’t present with any noticeable symptoms.

Even among the ones who do have symptoms, they are usually mild. Besides feeling an undue amount of vaginal pressure anytime you are constipated or backed-up, symptoms include difficulty pooping in general, feeling like your poop hasn’t been totally evacuated, and sometimes needing to insert a finger into your vagina to, um, help guide the poop out (I’m not just making this one up — it’s published guidance by MDs!).

Other lovely symptoms include discomfort with intercourse, vaginal bleeding, and a palpable bulge inside the vagina. In more advanced cases, women may experience fecal incontinence or fecal “smearing.”

Oh, the joys of owning a vagina, so conveniently located next to the anus!

Again, all of this is as a result of weakened pelvic muscles and a prolapse of the rectum so that it rests right against (but not inside!) the vaginal wall. And because pictures are worth a thousand words, especially when it comes to something like this, you might want to take a peek at what is happening anatomically when your rectum falls into that precarious place right smack against your vagina.

Compare the normal vagina (on the left) to a rectal prolapse (on the right):

It’s subtle, but if you look carefully, you can see that the rectum has sunk down in the second picture, and there is less room between the vagina and rectum. Unfortunately, prolapses like this can also happen to our other surrounding organs (think bladder and uterus) and can be brought on by childbirth, as well as general aging. In the case of rectoceles, chronic constipation can also be a contributing cause. Fantastic.

So what can be done if your rectocele is causing you discomfort?

According to the good people at the Mayo Clinic, certain lifestyle choices can lessen the symptoms of your rectocele. You want to try to prevent constipation by eating plenty of fibrous foods and drinking lots of water. Whenever possible, don’t bear down too much when you poop, avoid heavy lifting, and try not to cough too deeply (though you can’t always control that, obviously).

And of course, do your damn Kegels! Remember: Kegels aren’t just to keep your vagina toned. Kegels, or any exercise that strengthens your pelvic floor generally keeps all those organs in place and in good shape. It’s important to learn how to properly perform Kegels — and you might even consider looking into physical therapy for pelvic organ prolapse (yes, that’s totally a thing and may even be covered by your insurance).

If you’ve tried all the above measures and continue to experience symptoms that disrupt your everyday life, you can consider surgery as another option. However, as American Society of Colon and Rectal Surgeons explains, there are risks to the surgery, including “bleeding, infection, new onset dyspareunia (pain during intercourse), fecal incontinence, rectovaginal fistula (a communication between the rectum and vagina), as well as a risk that the rectocele may recur or worsen.”

YIKES.

On the bright side, the initial success rate for surgery is actually really great: 75–90% of patients report improvement. But after two years, that rate decreases to 50–60%, which sort of stinks. Of course, these are only statistics, though, and whether or not to have surgery is a personal decision and something you should discuss with your doctor.

So there you have it, folks. Like “mommy bladder” and uterine prolapse, rectoceles are a pretty common curse of womanhood, unfortunately. The good news is that you aren’t some freak for having one, and there are actually things you do to make the situation more manageable — because no one wants their rectum and vagina on such intimate terms. And we all deserve to feel vibrant, strong, and healthy.