What Is A Rectocele
A rectocele is a bulge of the front wall of the rectum into the vagina. The
rectal wall may become thinned and weak, and it may balloon out into the vagina
when you push down to have a bowel movement. Most rectoceles occur in women
where the front wall of the rectum is up against the back wall of the vagina.
This area is called the rectovaginal septum and may be a weak area in the female
anatomy. Other structures may also push into the vagina. The bladder bulging
into the vagina is called a cystocele. The rectum bulging into the vagina is
termed a rectocele. And the small intestines pushing down on the vagina from
above may form an enterocele. Although uncommon, men may also develop a rectocele.
rectocele may be present without any other abnormalities. In some cases, a
rectocele may be part of a more generalized weakness of pelvic support and
may exist along with a cystocele, urethrocele, and enterocele, or with uterine
or vaginal prolapse, rectal prolapse, and fecal or urinary incontinence.
What Can Cause A Rectocele?
The underlying cause of a rectocele is a weakening of the pelvic support structures
and thinning of the rectovaginal septum. Certain factors may increase the risk
of a woman developing a rectocele. These include birth trauma such as multiple,
difficult or prolonged deliveries, the use of forceps or other assisted methods
of delivery, perineal tears, or an episiotomy into the rectum or anal sphincter
muscles. In addition, a history of constipation and straining with bowel movements,
or hysterectomy may contribute to the development of a rectocele. Commonly,
these problems develop with age but they may occasionally occur in younger
women or in those that have not delivered children.
What Are The Symptoms Of A Rectocele?
Many women have rectoceles but only a small percentage of women have symptoms
related to the rectocele. Symptoms may be primarily vaginal or rectal. Vaginal
symptoms include vaginal bulging, the sensation of a mass in the vagina, pain
with intercourse or even something hanging out of the vagina that may become
irritated.Vaginal bleeding is occasionally seen if the vaginal lining of the
rectocele is irritated, but other sources of the bleeding should be checked
by your doctor. Rectal symptoms include constipation, particularly difficult
evacuation with straining. Often this is associated with bulging in the vagina
when straining to have a bowel movement.Some women find that pressing against
the lower back wall of the vagina or along the rim of the vagina helps to empty
the rectum. At times, there will be a rapid return of the urge to have a bowel
movement after leaving the bathroom because stool that was trapped in the rectocele
may return to the low rectum after standing up. A general feeling of pelvic
pressure or discomfort is often present but this may be due to a variety of
How Is A Rectocele Diagnosed?
Most rectoceles may be identified on a routine office examination of the vagina
and rectum. However, it may be difficult to assess the size and significance
of the rectocele. A more accurate method of assessing the rectocele is an x-ray
study called a defecagram. This study shows how large the rectocele is and
if it empties with evacuation.
When Should A Rectocele Be Treated?
You should consider having your rectocele treated when it causes significant
symptoms. It takes an experienced doctor to help you decide whether your symptoms
are caused by a rectocele. If there are multiple abnormalities present, it
may be best to address them all at once as this will result in the best chance
What Treatement Is Available For A Rectocele?
Rectoceles that are not causing symptoms do not need to be treated. In general,
you should avoid constipation by eating a high fiber diet and drinking plenty
A bowel management program is the best first step. This includes a diet high
in fiber and 6 to 8 glasses of fluids each day. Fiber acts like a sponge. It
soaks up fluid so that less is removed as the stool travels around the colon.
The stools will be larger, softer and easier to pass. You may wish to add a
fiber supplement and/or a stool softener to this regimen to improve stool consistency.
Most fiber supplements are made of psyllium, a seed product, or of a hydrophilic
colloid (gel) that absorbs water. Most stool softeners are composed of docusate.
This helps to smooth and lubricate the stool. Active laxatives are best avoided
in most cases.
Avoid prolonged straining. If you cannot completely empty, get up and return
later. Holding pressure with a finger to support the rectocele and encourage
the stool to go in the correct direction is often helpful. This may be accomplished
by pressing against the lower back wall of the vagina or along the posterior
rim of the vagina. Avoid placing a finger inside the anus to pull the stool
out as this may cause harm. A pessary may be used to support the pelvic organs.
It is a ring that is inserted into the vagina and must be individually fit
to each woman.
If symptoms persist even with medical therapy, then surgical repair may be
indicated. There are several surgical techniques used to repair a rectocele.
A rectocele repair may be performed through the anus, through the vagina, through
the perineum between the anus and vagina, or from above through the abdomen.
When there is extensive pelvic relaxation and prolapse, the best approach may
be a combined repair.
Who Should Treat Me For This Problem?
Both colorectal surgeons and gynecologists are trained to deal with these problems.
If the symptoms are entirely vaginal, then it is appropriate for your gynecologist
to address the problem. If your symptoms are rectal, then a colorectal surgeon
should be involved. If there is any question, seek opinions from physicians
of both specialties.
Reference: American Society
of Colon and Rectal Surgeons