What is a rectocele?
A rectocele can be described as a bulge in the wall of the rectum into the vagina. The wall of the rectum becomes thin and weak. It may balloon out into the vagina when you have a bowel movement.
There are other structures that may also balloon into the vagina. The bladder bulging into the vagina is a cystocele. The small intestine pushing down on the vagina from above is an enterocele. The uterus bulging into the vagina is called uterine prolapse.
How does it occur?
The wall that lies between the rectum (front wall of the rectum) and the vagina (back wall of the vagina) is called the rectovaginal septum. The thinning of the rectovaginal septum and weakening of the pelvic support structures is the underlying cause of a rectocele.
The most common cause is childbirth and chronic constipation. The muscles and ligaments in the pelvis that hold up and support the female organs and vagina become stretched and weakened during straining. The more babies you have, the more the support tissues are stretched and weakened. Not everyone who has a baby will develop a rectocele. Some women have stronger supporting tissue in the pelvis and may not have as much of a problem as others.
Other conditions that can cause a rectocele include chronic constipation, a chronic cough, a lot of heavy lifting, and obesity. Older women may have this problem because the loss of female hormones causes the vaginal tissue to become weaker.
What are the symptoms?
There may not be any symptoms. If you do have symptoms, they may include:
- Pelvic pressure in the rectal area
- Protrusion of the lower part of the vagina through the opening of the vagina
- Constipation and trapping of the stool, making it difficult to have a bowel movement (you may have to press on the lower part of your vagina to help push the stool out of your rectum, this is called splinting).
- A rapid urge to have a bowel movement after leaving the bathroom is caused by stool returning to the lower rectum that was trapped in the rectocele.
- Incontinence especially after having a bowel movement.
How is it diagnosed?
Your health care provider will ask about your symptoms and perform a pelvic exam. Your provider will ask you to bear down, pushing like you are having a bowel movement so he or she can see how far the lower part of the vagina protrudes into the vagina and possibly outside of the vagina. Your provider will also ask you to contract the muscles of your pelvis (like you are stopping the stream in the middle of urinating) to determine the strength of your pelvic muscles. Your provider may also do a rectal exam. You may also be asked to have a defecography. A defecography is a special x-ray that looks at the pelvic organs while you are straining like you are trying to have a bowel movement.
How is it treated?
- If the rectocele is not causing any symptoms, it need not be treated. Constipation should always be avoided. Eating a diet rich in fiber and drinking 6 to 8 glasses of decaffeinated fluid every day can assist in keeping bowel movements soft.
- Avoid prolonged straining. If the bowels will not completely empty after a bowel movement, get up and return later. A pessary (a ring that is inserted in the vagina) may be used to assist in supporting pelvic organs.
- Avoiding heavy lifting, and lifting correctly (with your legs, not with your waist or back)
- Treating a chronic cough or bronchitis
- Not smoking
- Avoiding too much weight gain
- Doing Kegel exercises, especially after you have a baby.
- Splinting, this is inserting a tampon or two fingers inside the vagina and pushing back.
- Surgical repair may be indicated if the rectocele is severe. A rectocele repair may be performed through the anus, vagina, perineum (between the anus and vagina), the abdomen, or may be a combined repair.
- Often a combination of non-surgical and surgical treatments is needed to correct the problem.
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