What is a Rectocele?
A rectocele or posterior vaginal prolapse is the bulging of the rectum into the vagina due to the weakening of the rectovaginal septum and pelvic floor muscles. The rectovaginal septum is made up of fibrous tissues separating the rectum and vagina. The pelvic floor muscles are the layer of muscles supporting the pelvic organs (bladder, bowel, and uterus).
Analogous to an abdominal wall hernia, once a rectocele becomes symptomatic, vaginal surgery is the most effective way of addressing it.
Risk Factors
Possible risk factors that may cause a rectocele to include:
- Childbirth
- Aging
- Chronic constipation
- Chronic cough associated with smoking or asthma
- Lifting very heavy objects
- Obesity
- Genetic factors
Symptoms
Small rectoceles are usually asymptomatic. Large rectoceles are associated with symptoms including:
- Bulging of the front wall of the rectum into the back wall of the vagina – which can protrude through the vaginal opening
- Need to digitally press on the vagina or perineum to be able to have a bowel movement
- Incomplete bowel movements and improper emptying of the rectum
- A feeling of pressure or fullness in the rectum
- Soiling with fecal material
- Sexual concerns or pain during intercourse
- Rectal pain or lower back pain
Diagnosis
Your doctor will diagnose a rectocele on pelvic exam, but may require radiologic tests such as an MRI in order to confirm an internal finding. Before planning a surgical repair, we may order one or both of the following tests:
- Bladder function testing (Urodynamics): This tests the ability of your bladder to store and eliminate urine. The volume and force of the urine stream are also measured. Since a large rectocele will push on the bladder, correcting it can result in less bladder support and even urinary incontinence – which should be identified pre-operatively so it can be addressed at the same time.
- Urinalysis: To make sure there is no UTI, blood in the urine, or other abnormalities.
Treatment
Initially, your doctor may suggest non-surgical methods to treat a rectocele. Surgery is recommended if non-surgical methods fail.
Non-surgical Methods
Your doctor may suggest the use of a vaginal pessary, which is a plug-like device to overcome the bulging tissue. Kegel exercises are also recommended to strengthen the muscles.
Surgical Methods
Your surgeon may perform any one of the following methods:
- Stitches may be used to correct the tear(s) in the tissues which are bulging between the rectum into the vagina.
- The muscles between the rectum and vagina are usually stretched by an enlarging rectocele, and they are sutured back together during a repair.
- Mesh is very rarely used to support and strengthen the wall between the rectum and the vagina.
Prevention
Kegel exercises have been known to prevent rectocele by strengthening the pelvic muscles. They can also be very important in preventing recurrence of a successfully repaired rectocele.
The occurrence of rectocele can be effectively prevented by following certain healthy lifestyle habits. They include:
- Managing constipation
- Losing weight, if obese
- Drinking plenty of fluids
- Eating high-fiber foods
- Avoiding lifting heavy objects
- Quitting smoking
- Managing a chronic cough
