What is a Rectocele?

A rectocele, or prolapse of the rectum, is when the rectum bulges into the vagina. A rectocele is different from a rectal prolapsed, where the rectum protrudes through the anus.

The rectum is the last 6 to 8 inches of the large intestine. It expands to store solid waste, and when full its muscular walls contract, forcing waste through the anorectal canal to the anus, where it is expelled from the body.

A mild rectocele may not have any symptoms. However, when present, common symptoms include:
•    A soft bulge in your vagina
•    Difficult bowel movements (constipation)
•    Feeling the need to press on the back part of your vagina in order to help push stool out during a bowel movement
•    The feeling of rectal heaviness
•    Feeling that the rectum is not completely empty following a bowel movement
•    Fecal incontinence

What Causes a Rectocele?

If your vaginal wall and pelvic floor weaken, your rectum loses its support and can bulge into your vagina. A rectocele often occurs as a result of heavy straining during childbirth. Additionally, as the baby moves through the birth canal, damage to the tissues can occur, sometimes resulting in a rectocele. Other repeated straining such as during bowel movements or heavy lifting can also lead to a rectocele.

As a woman goes through menopause, her estrogen levels fall. This leads to a weakening of the muscles surrounding the vagina, increasing the risk of prolapse.

A mild rectocele - Where the rectum has bulged into the vagina up to the pelvic floor muscles.

A more severe rectocele - Where the rectum has bulged through the entrance of the vagina, through a gap in the pelvic floor.

Other prolapses that can be seen with a rectocele include prolapse of the bladder (cystocele), prolapse of the small intestine (enterocele), and prolapse of the uterus.


How is a Rectocele Treated?

The treatment of a rectocele depends on the severity of it. If your rectocele is mild, pelvic floor strengthening and avoidance of heavy straining can help. More severe rectoceles may require the use of a pessary. A pessary is a device of various shapes and sizes that is placed in the vagina to support the rectum to keep it in place. The most severe rectoceles may require surgery to correct the positioning of the rectum.

To prevent worsening of your rectocele, you should consider the following:
•    Routine performance of pelvic floor muscle strengthening exercises
•    Avoidance or correction of obesity, chronic cough and repetitive straining through lifting or bowel movements
•    Increased daily intake of fiber and fluid to prevent constipation
•    Discussing the possibilities and risks of estrogen replacement therapy with your physician

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