Rectocele

Overview, Causes, & Risk Factors

Rectocele is a condition in which part of the rectum protrudes or bulges into the back wall of the vagina.

What is going on in the body?

The rectum lies just behind the vagina in a female. Between the rectum and vagina is a wall made of tissues and muscles that support the rectum and vagina. When a woman has a rectocele, the wall supporting the rectum is weaker than usual. This weakening allows part of the rectum to protrude into the vagina. As the rectum becomes stretched, it bulges into the vagina. The woman may experience difficulty passing stool.

What are the causes and risks of the disease?

Rectocele results from a weakening or stretching of the tissues supporting the rectum. The causes of this weakening include:

muscles and tissues being stretched during childbirth

heavy lifting that causes stress on the muscles surrounding the vagina and rectum

chronic constipation or repeated straining during bowel movements

obesity

excessive coughing, such as from lung disease

menopause. Estrogen helps keep the muscles around the vagina strong. During menopause, estrogen levels decrease.

normal aging, which can cause the muscles become weaker

Symptoms & Signs

What are the signs and symptoms of the disease?

Symptoms of a rectocele may include:

bulging of rectal tissue from the vagina

difficulty having a bowel movement

constipation

dyspareunia, or pain with sexual intercourse

the need for manual evacuation, in which fingers are placed in the vagina to push the rectum back in order to have a bowel movement

rectal pain

rectal bleeding

a feeling that the rectum has not been completely emptied after a bowel movement

leaking of stool from the rectum

low back pain

Diagnosis & Tests

How is the disease diagnosed?

Diagnosis of a rectocele begins with a complete history and physical, including a pelvic exam and rectal exam. Other tests may include:

ultrasound, which uses sound waves to show the uterus, bladder, rectum, and cervix

defecography, in which X-rays of the rectum are taken while the person has a bowel movement

stool culture, in which the stool is examined for bacteria

blood tests, including a complete blood count, or CBC, to check for infection

other X-rays, scans, or tests to rule out other causes of the symptoms

Prevention & Expectations

What can be done to prevent the disease?

This condition may not be preventable. Using caution when doing heavy lifting may decrease the risk. Careful monitoring, and an episiotomy if necessary, may prevent rectocele during childbirth.

Kegel exercises may strengthen the wall supporting the vagina and rectum. A pessary may help keep a rectocele from becoming worse. This is a device that can be put into the vagina to hold the rectum in place.

Staying active and eating a healthy diet with fiber, fruits, and vegetables may decrease constipation.

What are the long-term effects of the disease?

Long-term effects depend on the severity of the condition. Rectocele may lead to constipation, hemorrhoids, a hole in part of the intestine, or hard stool that blocks the intestine. Embarrassment about leaking stool can cause stress. Other long-term effects will depend on the success of treatment.

What are the risks to others?

Rectocele is not contagious and poses no risk to others.

Treatment & Monitoring

What are the treatments for the disease?

Treatment of rectocele is aimed at treating and reducing symptoms. These measures may help:

avoiding straining during bowel movements or heavy lifting

eating a healthy diet, especially one with more fiber

staying active

using stool softeners to keep stools soft

doing Kegel exercises to strengthen the muscles supporting the rectum and vagina

using a pessary, which is a device fitted into the vagina to hold the rectum in place

using hormone replacement therapy, or HRT, for postmenopausal women, which may help to strengthen the muscles around the vagina and rectum

the use of surgery for severe or persistent symptoms, or for a progressive rectocele. The goal of the surgery is to move the rectum back into its normal position and hold it there. The muscles of the vagina and rectum can also be strengthened with surgery.

What are the side effects of the treatments?

Medications used to treat constipation may cause side effects, including nausea, headache, or diarrhea. Surgery carries a risk of bleeding, infection, and allergic reactions to anesthesia.

What happens after treatment for the disease?

Treatments such as activity and diet modifications might be lifelong. Recovery from surgery may take a few days to several weeks, depending on the procedure used.

How is the disease monitored?

Any new or worsening symptoms should be reported to the healthcare provider.