Rectocele is a female condition in which the front wall of the rectum (the last part of the large intestine) pushes into the back wall of the vagina. Rectocele, also known as posterior vaginal prolapse, is a common condition, especially after the age of 50.

Rectoceles do not always cause symptoms, especially when they are small. It may be uncomfortable, but it is rarely painful.

Symptoms of a Rectocele

It is common to have a small rectocele. A small rectocele does not always cause any signs or symptoms. Many cases of rectocele are discovered by chance during a routine gynecological pelvic exam.

If you have rectocele symptoms, they can affect either the rectum or the vagina. Rectocele symptoms are usually mild when they occur.

Being unable to empty the bowels, constipation, the sensation that stool is becoming "stuck", having more frequent bowel movements, having to strain to have a bowel movement, incontinence, pain in the rectum, painful intercourse, and vaginal bleeding are all symptoms of a rectocele in the rectum.

Causes of a Rectocele

A rectocele can develop as a result of pressure on the pelvic floor caused by pregnancy, chronic constipation, being overweight or obese, having a chronic cough, or performing repetitive heavy lifting.

Rectoceles become more common as one gets older. Most of the time, the precise cause will not be known, especially because so many of the potential causes are common.

Pregnancy, Labor, and Delivery

The muscles of the vagina are stretched during pregnancy, labor, and delivery. Despite the fact that this is normal, the process can weaken those muscles, and people who have more pregnancies and vaginal deliveries are more likely to develop a rectocele.

More interventions during vaginal delivery, such as the use of a vacuum or forceps, an episiotomy, and vaginal tearing, can also contribute to the formation of a rectocele.

Surgeries

The pelvic floor can be weakened as a result of surgery. Having rectovaginal surgery, including rectum surgery and gynecological surgery such as a hysterectomy, can also contribute to the development of a rectocele.

Diagnosis

A rectocele is typically diagnosed during a pelvic exam, such as a yearly visit with a gynecologist, but other tests may be used in some cases.

Pelvic Exam

A pelvic exam can be performed with gloved fingers or with the use of a speculum, which is a metal instrument that helps a physician see the vagina and cervix.

During a pelvic exam, a woman lies down on an exam table and places her feet in stirrups on either side of the table so that the doctor can examine the vulva, vagina, and cervix.

The exam may be unpleasant. It should, however, not be painful and should only take a minute or two to complete.

Digital Rectal Exam

A gloved, lubricated finger is inserted into the rectum during a digital rectal exam. A physician can feel for any abnormalities or check for mucus or bleeding in the area by doing so. If you have a rectocele, the muscles in the rectum closest to the vagina may feel weaker.

The digital rectal exam can be performed with or without a pelvic examination. Both are sometimes performed during a routine yearly exam or when a rectocele is suspected.

Defecography

A defecography is an X-ray that examines what happens during a bowel movement. This test is not commonly used, but it can aid in determining the exact location and size of a rectocele.

Preparing for this test may entail performing an enema prior to the test and then fasting for a few hours.

Treatment

Rectoceles do not always cause signs or symptoms, and those that do not cause problems may not require treatment. When a rectocele interferes with a person's quality of life, treatments such as diet changes, biofeedback, or surgery may be used.

Diet Modifications

Making dietary changes may help if you have constipation or have to strain to have a bowel movement. Including more fiber in your diet can help make your stool softer and easier to pass.

The fiber found in fruits, vegetables, and whole grains can help prevent stool from becoming too hard and difficult to pass. Fiber supplements may also be beneficial, and a doctor can advise you on which type to try and how much to take.

Biofeedback

Biofeedback is a specialized type of therapy that can be used in conjunction with pelvic floor physical therapy. This may include using a monitoring device to measure muscle tightness and performing exercises like Kegels to strengthen the pelvic floor. A certified physical therapist who specializes in pelvic floor abnormalities can advise on the type of exercises and other therapies that will aid in the treatment of the rectocele.

Surgery

Another alternative to treat Rectocele is surgery. The most common surgical repair is a transvaginal rectocele repair, also called a posterior repair. The rectocele is reached through the vagina. It offers the chance to correct not only the rectocele but a thinned perineum and widened vaginal opening. It also has the advantage of not disturbing any tissue in the rectal area. This is the traditional approach to rectocele repair by urologists and gynecologists.