Rectocele
- Reviewed by Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
What is it?
In women, the vagina is separated from the rectum by a firm wall of tough, fibrous tissue called fascia. Sometimes, an area of this wall gets weak, and part of the rectum bulges into the vagina. This bulge is called a rectocele.
The problem usually develops after the wall is damaged during a vaginal delivery. The bulge may occur after a vaginal delivery, but symptoms may not develop until later in life. Rectoceles are more commonly seen in older women who have entered menopause.
Some conditions can increase the risk of developing rectocele, including chronic constipation, chronic cough, repetitive heavy lifting, or any activity that puts pressure on the pelvic floor over time.
Because small rectoceles often do not cause any symptoms, it is difficult for health experts to determine exactly how often they occur. As few as 20%, or as many as 80% of adult women may be affected, but rectoceles are most commonly seen in older women who have had multiple vaginal deliveries. In one recent study of 125 women in the United States who had rectoceles, the typical patient was about 60 years old, going through menopause, and had gone through two or three vaginal deliveries. A woman with a rectocele is also likely to have related conditions, including a cystocele (an abnormal bulging of the bladder through a weakness in the anterior vaginal wall) and uterine prolapse (abnormal sagging of the uterus into the vagina because of loss of its pelvic support).
Symptoms
A small rectocele may not cause any symptoms, especially if it bulges less than 2 centimeters (less than 1 inch) into the vagina. However, larger rectoceles can trigger a variety of rectal and vaginal complaints, including
- a bulge of tissue protruding through the vaginal opening
- constipation
- difficulty having a bowel movement
- pain or discomfort during sexual intercourse
- a feeling that the rectum has not emptied completely after a bowel movement
- a sensation of rectal pressure
- rectal pain
- difficulty controlling the passage of stool or gas from the rectum
- low back pain that is relieved by lying down. In many women, this back pain may worsen as the day goes on and is more severe in the evening.
In some cases, the patient must use a technique called manual evacuation or digitation to help empty the rectum. In this technique, the patient presses on the rectocele with her fingers while defecating to help the stool to pass.
Diagnosis
Your doctor will ask about the number of times that you've had a vaginal delivery, and about any problems, such as vaginal tears, you may have had with your deliveries. After reviewing your rectal and vaginal symptoms, your doctor also may ask about any urinary problems that suggest that you might have a cystocele as well as a rectocele.
In most cases, your doctor can confirm that you have a rectocele by doing a gynecological and a rectal examination. As you doctor examines you, he or she may ask you to strain or bear down as if you were trying to defecate. This straining maneuver should cause the rectocele to bulge, and allow the doctor to see the rectocele's size and location inside your vagina. At some medical centers, imaging tests of the rectum may be done to outline the size and location of the rectocele.
Expected duration
A rectocele is a long-term condition that does not heal on its own. It may remain a minor problem or become larger and more problematic with time.
Prevention
Some health experts believe that Kegel exercises can either help to prevent a rectocele or relieve some of its symptoms. Kegel exercises are muscle-strengthening maneuvers that help to tighten the tissues around the vagina, but they have not been proven to prevent rectoceles.
Treatment
If you are troubled by symptoms of a rectocele, you doctor likely will do surgery to repair the weakness in the fascia between your rectum and vagina. This repair may be done by reinforcing the area with stitches, or it may involve more complex techniques, such as placing a mesh patch to strengthen and support the wall between the rectum and vagina. If you also have a cystocele or uterine prolapse, then surgery to repair these conditions usually can be done at the same time as your rectocele repair.
A nonsurgical treatment called a vaginal pessary is available as an alternative. A pessary is a device shaped like a ring, block, or plug that is placed into the vagina to support the bulging tissues. Several types of pessaries are in use, some that you may be able to remove and clean daily, others that may require a doctor's visit for periodic removal and cleaning. Your doctor will decide which type of pessary is best for you, and will make sure it fits properly.
When to call a professional
Call your doctor promptly if you discover an abnormal bulge in the wall of your vagina, or if you suddenly develop severe rectal pressure, pain, or bleeding.
Call your doctor for an appointment if you suffer from chronic constipation, pain, or discomfort during sexual intercourse, or any difficulty passing stool.
Prognosis
When surgery is used to treat rectoceles, the structural problem can be repaired successfully in the majority of cases. Most patients experienced improvement or complete relief of their symptoms.
Additional info
American College of Obstetricians and Gynecologists
https://www.acog.org/
American Urogynecology Society (AUGS)
https://www.augs.org
Society of Gynecologic Surgeons (SGS)
https://sgsonline.org
About the Reviewer
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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