Rectocele

Overview

A rectocele is a type of pelvic organ prolapse in which the wall of tissue separating the rectum from the vagina weakens, allowing the rectum to bulge forward into the back wall of the vagina. It is also called a posterior vaginal prolapse.

Rectoceles are common, especially in women who have given birth or are past menopause. Many small rectoceles cause no symptoms and need no treatment. Larger ones can cause a noticeable bulge and make bowel movements difficult. The condition is not dangerous, but it can affect comfort and quality of life, and effective treatments are available.

Symptoms

Small rectoceles often cause no symptoms. Larger ones may cause:

• A soft bulge of tissue at the back wall of the vagina
• A feeling of fullness, pressure, or that something is falling out of the vagina
• Difficulty having a bowel movement, with a sense of incomplete emptying
• The need to press on the vagina or the area between the vagina and anus to complete a bowel movement
• Discomfort during intercourse

Symptoms are often worse after standing for a long time or straining, and may ease when lying down.

Causes

A rectocele develops when the muscles, ligaments, and tissue (the fascia) that support the pelvic organs and separate the rectum from the vagina become weak or stretched. Anything that increases pressure on the pelvic floor or weakens these tissues can contribute, including:

• Pregnancy and vaginal childbirth, especially difficult or repeated deliveries
• Aging and the drop in estrogen after menopause
• Chronic straining from constipation
• Long-term coughing, such as from chronic lung disease or smoking
• Heavy lifting
• Previous pelvic surgery, such as a hysterectomy

Risk Factors

• Vaginal childbirth, particularly multiple or complicated deliveries
• Older age and menopause
• Chronic constipation and straining
• Being overweight, which adds pressure on the pelvic floor
• Chronic cough
• A family tendency toward weaker connective tissue
• Prior pelvic or vaginal surgery

Diagnosis

A rectocele is usually diagnosed during a pelvic examination:

• Pelvic exam: The doctor looks and feels for a bulge in the back wall of the vagina, sometimes asking you to bear down or stand so the bulge becomes more obvious.
• Rectovaginal exam: Examining the rectum and vagina together to assess the strength of the tissue between them.
• Imaging: Occasionally, a special X-ray (defecography) or MRI is used to see how the rectum empties and to assess the prolapse, especially before surgery.

Treatment

Treatment depends on how bothersome the symptoms are. Many rectoceles need no treatment at all.

• Self-care: Avoiding constipation and straining with a high-fiber diet, plenty of fluids, and not delaying bowel movements often improves symptoms.
• Pelvic floor exercises: Strengthening the pelvic muscles (Kegel exercises), often with the help of a physical therapist, can ease mild symptoms.
• Pessary: A removable device placed in the vagina supports the prolapse and relieves the bulge without surgery.
• Surgery: For larger or troublesome rectoceles, a procedure to repair and reinforce the wall between the rectum and vagina may be recommended.

Prevention

You can lower the risk of a rectocele forming or worsening by protecting your pelvic floor:

• Prevent constipation with fiber, fluids, and regular bowel habits, and avoid straining
• Do pelvic floor exercises, especially after childbirth
• Maintain a healthy weight
• Treat a chronic cough and avoid smoking
• Use safe lifting techniques and avoid repeated heavy lifting

When to See a Doctor

See a doctor if you notice a bulge in the vagina, a feeling of pressure or fullness, or difficulty having bowel movements that affects your daily life. While a rectocele is not dangerous, a doctor can confirm the diagnosis, rule out other causes, and discuss treatments.

Seek prompt care if you have rectal bleeding, severe pain, or are unable to pass stool, as these may point to a different problem that needs evaluation.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Posterior vaginal prolapse (rectocele) — Symptoms and causes.
2. MedlinePlus, U.S. National Library of Medicine. Rectocele.
3. American College of Obstetricians and Gynecologists (ACOG). Pelvic Support Problems.
4. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).