Understanding Causes and Treatments of Rectocele

Written by Medicover Team and Medically Reviewed by Dr Thajammul Samrin , Gynecologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Rectocele, a form of pelvic organ prolapse, occurs when the rectum bulges into the back wall of the vagina due to a weakening of the pelvic floor muscles. This condition can cause discomfort and bowel issues, and can significantly affect a person's quality of life. Understanding rectocele is crucial for early diagnosis, prevention, and effective treatment.

Types of Rectocele

Rectoceles are generally classified based on their severity:

Mild Rectocele: Minor bulging of the rectum into the vagina.
Moderate Rectocele: More pronounced bulging that may cause discomfort.
Severe Rectocele: Significant protrusion that can cause considerable discomfort and bowel dysfunction.

What Are the Symptoms of Rectocele?

Symptoms vary depending on the severity of the rectocele, but common symptoms include:

A noticeable bulge in the vagina
Difficulty with bowel movements
Sensation of rectal pressure
Discomfort or pain during intercourse
Lower back pain

What Causes Rectocele?

Several factors contribute to the development of a rectocele:

Childbirth: Vaginal deliveries can stretch and weaken the pelvic floor muscles.
Chronic Constipation: Repeated straining can stress and weaken the pelvic floor.
Aging: Natural loss of muscle tone and elasticity in the tissues.
Heavy Lifting: Regular heavy lifting can put excessive pressure on the pelvic floor.
Previous Pelvic Surgery: Surgical procedures can weaken the supportive tissues.

When Should You See a Doctor for Rectocele?

Medical evaluation is recommended if rectocele symptoms interfere with bowel movements, daily activities, or quality of life. Early diagnosis helps prevent worsening prolapse and allows timely treatment through lifestyle changes, pelvic floor therapy, or surgery when necessary. Rectocele is commonly evaluated and treated by a gynecologist, urogynecologist, colorectal surgeon, or general surgeon, depending on its severity.

You should see a doctor if you have:

A persistent vaginal bulge or sensation of pressure.
Difficulty passing stools or needing to press on the vagina to complete bowel movements.
Pain during intercourse or ongoing pelvic discomfort.

Get medical help immediately if:

Severe pelvic pain with sudden worsening of symptoms.
Heavy rectal or vaginal bleeding.
Inability to pass stool or severe constipation associated with abdominal pain.

These could be signs of a serious complication of rectocele that requires prompt medical care.

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How is Rectocele Diagnosed?

Diagnosing rectocele involves reviewing your symptoms, performing a pelvic examination, and, when necessary, using imaging tests to determine the severity of the prolapse. These evaluations help your healthcare provider recommend the most appropriate treatment plan.

Medical History and Physical Examination

Diagnosis typically begins with a thorough medical history and a physical examination. Your healthcare provider will ask about your symptoms and perform a pelvic exam to check for bulging in the vaginal wall.

Imaging Tests

In some cases, imaging tests such as MRI or ultrasound may be recommended to provide a clearer picture of the extent of the prolapse.

Defecography

Defecography, a specialized X-ray, can also be used to assess the function and structure of the rectum and pelvic floor during bowel movements.

What is the Treatment for Rectocele?

Treatment for rectocele depends on the severity of symptoms and the impact on daily life. Options range from conservative measures and pelvic floor rehabilitation to surgical repair for more advanced or persistent cases.

Lifestyle Modifications

Dietary Changes: High-fiber diet to prevent constipation.
Pelvic Floor Exercises: Strengthening the pelvic floor muscles through Kegel exercises.
Avoiding Heavy Lifting: Reducing activities that increase abdominal pressure.

Pessary

A pessary is a device inserted into the vagina to support the rectal bulge and relieve symptoms. It's a non-invasive treatment option for those who cannot or prefer not to undergo surgery.

Rectocele Repair Surgery

For more severe cases, surgical intervention may be necessary. Rectocele repair, also known as posterior colporrhaphy, involves tightening the rectovaginal fascia and pelvic floor muscles to restore normal anatomy.

Minimally Invasive Surgery

Some patients may be candidates for minimally invasive surgery, such as laparoscopic or robotic-assisted procedures, which offer quicker recovery times and reduced postoperative pain.

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What is the Difference Between Cystocele and Rectocele?

Although both conditions are forms of pelvic organ prolapse, they affect different pelvic organs and may cause different symptoms. Identifying the type of prolapse helps guide the most suitable treatment approach.

While both cystocele and rectocele involve prolapse, they affect different organs:

Cystocele: Prolapse of the bladder into the front wall of the vagina.
Rectocele: Prolapse of the rectum into the back wall of the vagina.

How is Recovery Managed After Rectocele Surgery?

Recovery after rectocele surgery focuses on promoting healing, preventing complications, and reducing the risk of recurrence. Following your healthcare provider's instructions is essential for achieving the best long-term outcome.

Immediate Post-Operative Care

Pain Management: Medications to control pain and discomfort.
Activity Restrictions: Avoiding heavy lifting and strenuous activities during recovery.
Bowel Management: Stool softeners and high-fiber diet to prevent straining.

Long-Term Management

Pelvic Floor Rehabilitation: Physical therapy to strengthen pelvic muscles.
Regular Follow-Ups: Monitoring for recurrence and ensuring proper healing.

How Can Rectocele Be Prevented?

While not all rectoceles can be prevented, certain measures can reduce the risk:

Maintaining a Healthy Weight: Reducing pressure on the pelvic floor.
Avoiding Constipation: High-fiber diet and plenty of fluids.
Regular Pelvic Floor Exercises: Strengthening the pelvic muscles to provide better support.

What Are the Complications of Rectocele?

If left untreated, rectocele can worsen over time and interfere with bowel function, pelvic support, and daily activities. Recognizing possible complications allows for timely treatment and helps reduce the risk of long-term problems.