A rectocele is a herniation of the front wall of the rectum into the back wall of the vagina. The tissue between the rectum and the vagina is known as the rectovaginal septum and this structure can become very thin and weak over time, which results in a rectocele. When rectoceles are small, most women have no symptoms. A rectocele may be an isolated finding or occur as part of a generalized weakening of the pelvic floor muscles. Other pelvic organs such as the bladder and the small intestine, can bulge into the vagina, leading to similar symptoms as rectocele.
A rectocele is one type of pelvic organ prolapse, in which the rectum bulges into the back wall of the vagina. Other types of prolapse are:
- Anterior wall prolapse or cystocele, where the bladder bulges into the back wall of the vagina
- Uterine prolapse when the uterus hangs down into the vagina
- Vault prolapse, in which the top (or vault) of the vagina bulges down after a hysterectomy.
What are the symptoms of a rectocele?
A small posterior prolapse may cause no signs or symptoms. Otherwise, you may notice:
- A soft bulge of tissue in the vagina that may or may not protrude through the vaginal opening
- Difficulty having a bowel movement with the need to press your fingers on the bulge in your vagina to help push stool out during a bowel movement
- A feeling that the rectum has not completely emptied after a bowel movement
- Sexual concerns, such as feeling embarrassed or sensing looseness in the tone of your vaginal tissue
The underlying cause is a weakening of the pelvic support structures and of the rectovaginal septum, which is the layer that separates the vagina from the rectum. The most common cause is childbirth, especially if the newborn is big, weighing over nine pounds. The more vaginal births a woman has had, the higher her risk. The risk is significantly lower with a cesarean delivery. Women who have never given birth can also develop a rectocele.
The following are risk factors:
- A drop in estrogen levels at the menopause, making pelvic tissues less elastic
- A hysterectomy
- Chronic constipation
- Pelvic surgery
- Sexual abuse during childhood
- Being obese or overweight.
How is rectocele treated?
If conservative measures fail, your physician may recommend surgery in order to help fix vaginal prolapse. He may discuss your age and general health, desire for future pregnancies, wish to preserve vaginal function, the degree of prolapse and anatomic conditions that affect decisions as to which surgical procedure to pursue. For instance, a hysterectomy (removal of the uterus) may be required when significant prolapse is present.
There are two primary approaches depending on the condition. Many surgeries are conducted through the vagina, an approach that leaves no scars, while laparoscopy is an increasingly practiced method of repairing prolapse. These procedures are conducted through narrow tubes inserted through incisions less than an inch long. These procedures have been shown to reduce scarring, blood loss, and hospital stays, and speed recovery times.
Laparoscopic procedures are employed to relieve stress incontinence, repair hernias at the top of the vagina, and to create support for vagina’s that have become weakened by a hysterectomy. In instances in which supporting tissues have been weakened, additional natural tissue or artificial materials may be placed in order to support the repair.
A number of actions can reduce the chance of developing a rectocele or making it worse. Women who have recently given birth should do Kegel exercises regularly. Anyone with a chronic cough, chest infections, and other lung problems should seek medical attention as soon as possible.