A cystocele happens when the bladder drops from its normal position and presses into the front wall of the vagina. A rectocele happens when the rectum bulges into the back wall of the vagina. Both are common types of pelvic organ prolapse, and both are treatable, often without surgery.
Noticing a bulge at the vaginal opening, or a pressure that builds by evening, sends many women straight to a search bar and then into worry. Dr. Gregory J. Bailey, a board-certified urogynecologist, has treated pelvic floor disorders in Gainesville for more than 20 years, and these two conditions are among the most common reasons patients come to see us. Both respond well to treatment, and most women start with options far gentler than surgery.
What Is a Cystocele?
A cystocele, also called a prolapsed or fallen bladder, develops when the wall of supportive tissue between the bladder and the vagina weakens and the bladder drops down into the vagina, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Because the bladder sits in front of the vagina, the bulge appears along the front (anterior) vaginal wall.
Symptoms usually build gradually. Women with a cystocele often notice:
- A bulge they can see or feel at the vaginal opening
- Pelvic pressure or fullness that worsens with standing, lifting, or as the day goes on
- Urine leakage, especially with coughing, sneezing, laughing, or exercise
- A feeling that the bladder never quite empties
- Urinary tract infections that keep coming back
A mild cystocele may cause no symptoms at all. Some women only learn they have one during a routine pelvic exam, and a symptom-free prolapse often needs nothing more than monitoring.
What Is a Rectocele?
A rectocele is the mirror image. The rectum sits behind the vagina, separated by its own layer of supportive tissue. When that layer weakens, the rectum bulges forward into the back (posterior) vaginal wall, as the Cleveland Clinic explains.
With a rectocele, the telltale symptoms shift from bladder to bowel:
- A soft bulge in the vagina, sometimes more noticeable during bowel movements
- Constipation, or straining to pass stool
- A sense that the rectum doesn’t empty completely
- Needing to press on the back vaginal wall or nearby skin to finish a bowel movement, a workaround called splinting
- Pressure or discomfort in the vagina or rectum
Small rectoceles are common and frequently cause nothing. Larger ones tend to announce themselves in the bathroom.
How Do Cystocele and Rectocele Symptoms Compare?
Both conditions produce a vaginal bulge and pelvic pressure, so the location of the bulge and your bathroom habits are what separate them. A cystocele involves the bladder and the front vaginal wall, so it tends to cause urinary symptoms. A rectocele involves the rectum and the back wall, so it tends to cause bowel symptoms.
| Cystocele | Rectocele | |
|---|---|---|
| Organ involved | Bladder | Rectum |
| Vaginal wall affected | Front (anterior) | Back (posterior) |
| Bathroom symptoms | Urine leakage, weak stream, incomplete bladder emptying | Constipation, straining, incomplete bowel emptying |
| Other clues | Repeat urinary tract infections | Pressing on the vaginal wall to pass stool (splinting) |
| Shared symptoms | Vaginal bulge, pelvic pressure or heaviness, discomfort with intimacy | |
In practice, the symptoms overlap, and many women have more than one type of prolapse at once. A bulge can also come from uterine prolapse, when the uterus itself descends, which is one reason self-diagnosis only goes so far. If you’re feeling a bulge and want answers instead of guesses, request an appointment with our team.
What Causes a Cystocele or Rectocele?
The same underlying problem drives both: weakened support. The pelvic floor works like a hammock of muscle and connective tissue holding the bladder, uterus, vagina, and rectum in place. Anything that stretches, strains, or thins that hammock can let an organ drop.
The most common contributors include:
- Pregnancy and vaginal childbirth, the single biggest factor for many women
- Chronic constipation and years of straining on the toilet
- A long-standing cough, such as from smoking or asthma
- Repeated heavy lifting, whether at work or in the gym
- Menopause, because falling estrogen thins and weakens pelvic tissue
- Aging, extra body weight, and genetics, since connective tissue strength runs in families
- Prior pelvic surgery, including hysterectomy
Most of that list is ordinary life. Pelvic floor disorders affect roughly one in four US women, according to research funded by the National Institutes of Health, and prolapse is one of the most common among them. Developing one doesn’t mean you did anything wrong.
How Are Cystoceles and Rectoceles Diagnosed?
Diagnosis is simpler than most patients expect. A pelvic exam in the office is usually all it takes. Dr. Bailey examines the vaginal walls while you bear down, which shows how far the bladder or rectum has dropped and which walls are involved. Sometimes we repeat the check while you stand, since gravity can reveal a prolapse that stays hidden on the exam table.
If you’re also leaking urine or having trouble emptying your bladder, simple bladder testing may follow at a later visit. Nothing about the evaluation requires special preparation, and every question you’re nervous to ask is one we’ve answered many times before. Our post on what a urogynecologist actually does explains when it makes sense to move beyond your regular OB-GYN.
How Are Cystoceles and Rectoceles Treated?
We always begin with the least invasive options and progress thoughtfully based on your symptoms, anatomy, and goals. Cystoceles and rectoceles share nearly the same treatment ladder, which is convenient when both are present at once.
Nonsurgical treatment options
- Watchful monitoring. A mild prolapse that isn’t bothering you doesn’t need fixing. We keep an eye on it and act only if symptoms change.
- Pelvic floor physical therapy retrains and strengthens the muscles that support the pelvic organs, and it helps with the leakage and emptying problems that ride along with prolapse.
- Pessary fitting. A pessary is a small, removable silicone device worn inside the vagina to hold the prolapsed wall in place. Fitting happens in the office, and we adjust the size and shape until it sits well for you.
- Topical vaginal estrogen helps tissue that has thinned after menopause.
- Bowel and lifestyle habits. Treating constipation, adding fiber and fluids, and adjusting how you lift all reduce the daily strain on the pelvic floor, which matters most for a rectocele.
Many patients get relief from this list alone and never need anything more.
Surgical repair
When a prolapse is large or conservative care hasn’t brought enough relief, surgery restores the support directly. Dr. Bailey performs vaginal prolapse repair, which reinforces the weakened front or back wall through the vagina, and robotic sacrocolpopexy, a minimally invasive operation that restores support for prolapsed pelvic organs. When stress incontinence accompanies a cystocele, a mid-urethral sling can often be placed during the same procedure.
Every plan is individualized, never one-size-fits-all. You can read about the full range of options on our pelvic health and urogynecology page.
When Should You See a Doctor About a Prolapse?
Prolapse rarely calls for an emergency visit, but some signals deserve an appointment sooner rather than later:
- A bulge you can feel or see at the vaginal opening
- Pelvic pressure that interferes with work, exercise, or intimacy
- Leaking urine, or a bladder that won’t fully empty
- Constipation that started or worsened alongside the pressure
- Needing to press on the vaginal wall to have a bowel movement
None of these are things to be embarrassed about, and none of them are things you simply have to accept. The earlier we see a prolapse, the more choices you have, and the more likely a gentle option will be enough.
Frequently Asked Questions
How do I know if I have a cystocele or a rectocele?
Pay attention to which set of symptoms leads. Urine leakage, a weak stream, or a bladder that won’t fully empty points toward a cystocele. Constipation, straining, or needing to press near the vagina to pass stool points toward a rectocele. Symptoms alone can’t confirm the diagnosis, though. A brief pelvic exam settles the question, and it’s the only reliable way to know which walls are involved.
What happens if a cystocele or rectocele goes untreated?
In most cases, nothing dangerous. A mild prolapse without symptoms can simply be monitored, and some never progress. Others enlarge gradually over years, and symptoms like leakage, pressure, or constipation can become more disruptive. Waiting rarely takes your options away, but there’s no reason to put up with symptoms that already bother you. Treatment options exist at every stage.
Can you still have a bowel movement with a rectocele?
Yes. A rectocele changes the path stool travels rather than blocking it. Stool can settle into the bulge, which creates that not-quite-finished feeling, and some women press on the back vaginal wall to help things along, a technique called splinting. Managing constipation, pelvic floor physical therapy, and pessary support all help, and surgical repair can correct the weakened wall itself.
Can you feel a cystocele with your fingers?
Often, yes. Many women can feel a soft, smooth bulge just inside the vaginal opening, especially while standing or bearing down. Feeling a bulge tells you support has weakened, but it can’t tell you whether the bladder, rectum, or uterus is behind it. Rather than guessing, let a quick exam identify exactly what has shifted.
Can you have a cystocele and a rectocele at the same time?
Yes, and we commonly see both together. The pressures that weaken the front vaginal wall usually strain the back wall too. The good news is that treatment overlaps: a single pessary can often support both walls, pelvic floor physical therapy strengthens the whole floor at once, and both walls can be repaired during a single operation if surgery is ever needed.
Talk With a Pelvic Floor Specialist in Gainesville
A bulge you can feel, leaks you plan your day around, or bathroom trips that take real effort. None of that has to be your new normal. Dr. Bailey and our team have spent more than 20 years helping women across Gainesville and North Central Florida understand and treat pelvic floor disorders, starting with the gentlest option that works.
Well Balanced Healthcare is located at 6440 W Newberry Rd #409, Gainesville, FL 32605. Call (352) 333-6161, Monday through Friday, 8 am to 5 pm, or request an appointment online. You don’t have to live with this.