Rectocele (Posterior/Back Vaginal Wall Prolapse): Causes, Symptoms and Treatment

Rectocele vs Rectal Prolapse: What’s the Difference?

• Rectocele = a type of posterior vaginal wall prolapse where the front wall of the rectum bulges into the back wall of the vagina.
  • It occurs in women because it involves the vaginal wall.
  • In severe cases, the bulge may protrude through the vaginal opening, not through the anus.
• Rectal prolapse = the rectum itself telescopes down and protrudes through the anus.
  • This can occur in women, men, and children.
  • The prolapsing tissue comes out of the anus, not into the vagina.

As with most medical problems, it’s important not to put off treatment. Allowing your prolapse to go untreated for a long period of time leads to weakened pelvic muscles and damage to associated nerves - increasing the risk of it reoccurring. So avoid unnecessary delays and speak to your doctor if you have any concerns.

Types of Pelvic Organ Prolapse: Cystocele, Rectocele,  and Apical Prolapse

• Front Wall Prolapse (Cystocele) – The bladder bulges into the front wall of the vagina due to weakened pelvic floor support. Also known as a Bladder Prolapse. Anterior Prolapse, Dropped Bladder or Fallen Bladder.
• Back Wall Prolapse (Rectocele) – The rectum bulges into the back wall of the vagina, often causing pressure, discomfort or bowel symptoms. Also known as Back Wall Vaginal Prolapse, posterior Vaginal Wall Prolapse.
• Apical Prolapse – The top of the vagina, cervix or uterus drops down into the vaginal canal because of weakened supporting tissues, also known as Uterine Prolapse or Upper Vaginal Prolapse.

What Are the Stages of a Rectocele Prolapse?

A rectocele doesn’t always become severe, it may always remain a mild problem. However, it is important to acknowledge when symptoms progress and treat them accordingly:

• Mild rectocele prolapse – A mild rectocele is when you may not notice that you have a rectocele developing as there are no associated symptoms presenting themselves. You may only be diagnosed following a routine examination or procedure such as a smear test.
• Moderate rectocele prolapse – If your rectocele becomes worse, then you may begin to experience some, or all of the symptoms listed above. You may also notice that your rectocele becomes more pronounced if you strain during a bowel movement, or cough violently. During these times, you may notice or feel red tissue protruding from the vagina that retracts back when you’ve finished straining or coughing.
• Severe rectocele prolapse – Eventually, your rectocele may become severe and you’ll be experiencing symptoms that get worse throughout the day. In this case, your rectum may be protruding permanently through your vagina.

What Are the Symptoms of a Rectocele Prolapse?

A rectocele prolapse is not always accompanied by any obvious symptoms, as the pelvic floor muscles may have weakened over many years. Generally, if the rectum bulges into the vagina to a depth of less that 2cm (1 inch), you may not experience any discomfort. In fact, 40% of women with a rectocele prolapse are only diagnosed by a routine examination or procedure such as a smear test.

Some of the common symptoms that you may experience for a rectocele prolapse include:

• a protrusion or bulge into the vagina that you can feel through every day movements
• a feeling that something is inside the vagina
• pain or discomfort during sex
• constipation
• pain in the rectum
• unusual bleeding that isn’t associated with your period
• a feeling of pressure in the rectum
• difficulty passing a bowel movement, as the effects of the bulge become more noticeable
• a feeling that the bowel hasn’t completely emptied after a bowel movement
• finding it hard to hold in a stool  faecal incontinence and wind flatus incontinence
• lower back or pelvic pain that is relieved by lying down
• lower back or pelvic pain that gets progressively worse during the day or whilst standing and is at its worst in the evening

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. Visiting your doctor to get a diagnosis is important, and can help you decide which course of treatment is best for you.

Similar symptoms can also be experienced with Irritable Bowel Syndrome (IBS) and as such, a rectocele prolapse can often be misdiagnosed as IBS.

What Causes a Rectocele or Back Wall Prolapse?

Rectoceles are usually caused by weakening of the pelvic floor muscles and supporting tissues. Pregnancy, childbirth, menopause and ageing are among the most common reasons, but anything that places repeated pressure on the pelvic floor can contribute.

Risk factors include:

• Pregnancy and vaginal childbirth
• Multiple or difficult births
• Menopause and hormonal changes
• Being overweight
• Chronic constipation and straining
• Persistent coughing
• Heavy lifting or high-impact exercise
• Previous pelvic surgery or hysterectomy
• Genetics and naturally weaker connective tissues

The good news is that many women can successfully manage symptoms by Strengthening your pelvic floor muscles, lifestyle changes and pelvic floor exercises. Kegel8 pelvic floor trainers may help support muscle strength, bladder and bowel control, and prolapse symptom management.

How Can I Manage a Rectocele or Back Wall Prolapse?

If you have a rectocele, there are many ways to help manage symptoms, support your pelvic floor and reduce further prolapse progression. Small lifestyle changes, pelvic floor exercises and the right support products can make a big difference.

• Strengthen your pelvic floor muscles – Pelvic floor (Kegel) exercises can help improve muscle support, bladder and bowel control, and prolapse symptoms. A pelvic floor exerciser such as the Kegel8 Ultra 20 can help target and strengthen muscles, even if they feel very weak.
• Maintain a healthy body weight – Excess weight places additional pressure on the pelvic floor and may worsen prolapse symptoms. Carrying excess weight places additional downward pressure on the pelvic floor muscles, bladder, and pelvic organs. See How Weight Loss Can Help Pelvic Organ Prolapse, Bladder Leaks & Pelvic Floor Health
• Prevent constipation and straining – Eating a fibre-rich diet, drinking plenty of water and avoiding straining on the toilet can help reduce pressure on the pelvic floor. A toilet stool may help improve bowel emptying, while a vaginal splint such as Femmeze can help support bowel movements.
• Lift safely – Heavy lifting and incorrect lifting techniques increase strain on the pelvic floor. Keep loads close to your body and avoid heavy lifting where possible.
• Choose low-impact exercise – Gentle exercise such as walking, swimming, Pilates or cycling may be more suitable than high-impact activities like running or jumping. See How to Exercise Safely with a Prolapse
• Treat persistent coughing – Ongoing coughing places repeated pressure on the pelvic floor. Seek medical advice for a cough that does not improve. 
• Support your pelvic floor daily – SRC Restore Shorts and Leggings are designed to provide targeted pelvic and abdominal support during recovery and everyday activities.

With the right pelvic floor treatment plan and support, many women are able to successfully manage rectocele symptoms and improve their quality of life.

Simple Changes That Can Make a Big Difference

If you have a rectocele or back wall prolapse, there are many things you can do to help manage symptoms, support your pelvic floor and feel more in control. Small daily changes really can make a big difference — and for many women, surgery is not the first or only option.

Strengthen Your Pelvic Floor

Pelvic floor exercises (Kegels) help strengthen the muscles supporting your pelvic organs. Done regularly, they may help reduce feelings of pressure, heaviness and bladder or bowel symptoms.

A pelvic floor exerciser such as the Kegel8 Ultra 20 can help activate and strengthen weak muscles, even if you struggle to feel them working. It strengthens the muscles that support your pelvic organs, and also calms bladder nerves.

Avoid Pressure on Your Pelvic Floor

Reducing strain on the pelvic floor can help stop symptoms from worsening. Helpful changes include:

• Avoid straining on the toilet using a toilet stool reduces straining by 90%.
• Prevent constipation with fibre and water
• Lift carefully and avoid heavy lifting
• Manage coughing and stop smoking if possible
• Maintain a healthy body weight

Choose Prolapse-Friendly Exercise

Staying active is important, but high-impact exercise can sometimes worsen prolapse symptoms. Lower-impact activities such as walking, swimming, cycling and Pilates are often more comfortable and supportive for the pelvic floor. Learn How to Exercise Safely with a Prolapse with Kegel8.

Get Extra Support

Products such as vaginal pessaries, pelvic floor trainers and SRC support garments may help relieve pressure and improve comfort during everyday activities.

Surgery Is Usually a Last Resort

Many women successfully manage prolapse symptoms without surgery. If symptoms remain severe and affect daily life, your doctor may discuss surgical treatment options with you.

The most important thing to remember is this: you are not powerless. With the right pelvic floor support, exercises and lifestyle changes, many women are able to successfully manage prolapse symptoms and feel confident, comfortable and active again.

Rectocele Surgery: Is It a Last Resort?

Surgery for a rectocele or back wall prolapse is usually considered a last resort, after non-surgical treatments such as pelvic floor exercises, lifestyle changes and pessary support have been tried. Many women are able to successfully manage prolapse symptoms without needing surgery.

Rectocele repair surgery is generally recommended when symptoms are severe, affect daily life, or cause significant bowel problems, discomfort or vaginal bulging.

The operation aims to repair and strengthen the weakened tissue between the rectum and vagina, helping to reposition the rectum back into its normal place. Surgery is most commonly performed through the vagina, although some procedures may be carried out through the rectum or abdomen depending on the severity and type of prolapse.

Recovery typically takes several weeks, and during this time heavy lifting, straining, sex and high-impact exercise should be avoided. As with any surgery, there are risks involved and prolapse can sometimes return over time, which is why ongoing pelvic floor exercises and prolapse management remain important after recovery.

If you do choose surgery, it’s important to remember that while the procedure repairs and supports the prolapse, it does not strengthen the pelvic floor muscles themselves. Pelvic floor exercises remain an important part of both recovery and long-term prolapse management, helping to improve pelvic support and reduce the risk of symptoms returning.

Kegel8 is here to support you both before and after surgery, with expert pelvic floor rehabilitation support and a dedicated 12-week pelvic floor recovery programme designed to help strengthen your pelvic floor safely and effectively during recovery.

Sources

Allen, N. L. Beck, D. E. (2010). Clinics in Colon and Rectal Surgery. Rectocele. [online] 23(2), p 90-98. [viewed 12/05/2026]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2967328/

Bellini, M. Bertani, L. De Bortoli, N. Gambaccini, D. Marchi, S. Stasi, C. Usai-Satta, P. (2015). World Journal of Gastroenterology. Irritable bowel syndrome and chronic constipation: Fact and fiction. [online] 21(40), p 11362-11370. [viewed 12/05/2026]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4616212/

NHS Guys & St Thomas' Transvaginal rectocele repair and levatorplasty [viewed 12/05/2026]

British Society of Urogynaecology Patient Leaflet. [viewed 12/05/2026]. Posterior Vaginal Wall Repair without the use of mesh

What is a Prolpase? Bladder & Bowel UK [viewed 12/05/2026]