Rectocele: Symptoms, Causes, Treatment

What are the symptoms of rectocele?

Rectocele, also known as posterior vaginal prolapse, occurs when the wall between the rectum and the vagina weakens, causing the rectum to bulge into the vagina. The symptoms can vary in severity but commonly include:

• Vaginal Bulge or Pressure: A noticeable bulge in the vaginal area is often the most common symptom. This bulge may become more pronounced during activities like standing, lifting, or straining. Some women feel a sensation of pressure or fullness in the pelvic region.
• Difficulty with Bowel Movements: Many women with rectocele experience difficulty with bowel movements, including the need to press on the vagina or perineum to help evacuate stool. There may also be a feeling of incomplete bowel evacuation.
• Constipation: Chronic constipation or straining during bowel movements can be both a cause and a symptom of rectocele. The condition can make it harder to pass stool, leading to a cycle of worsening symptoms.
• Vaginal Discomfort: Some women experience discomfort or pain during intercourse, which may be related to the pressure or bulging in the vaginal area.
• Urinary Symptoms: Although less common, some women may experience urinary symptoms such as increased frequency, urgency, or difficulty emptying the bladder.
• Tissue Protrusion: In more severe cases, the rectal tissue may protrude through the vaginal opening, especially when straining or standing for long periods.
• Lower Back Pain: Some women report lower back pain, which may be associated with the pelvic pressure caused by the rectocele.

Symptoms can worsen over time, particularly with activities that increase intra-abdominal pressure, such as heavy lifting or straining during bowel movements. If any of these symptoms are present, it is important to seek medical evaluation for proper diagnosis and treatment.

What are the causes of rectocele?

Rectocele is caused by a weakening of the supporting tissues and muscles between the rectum and the vagina. Several factors can contribute to this weakening and lead to the development of a rectocele:

1. Childbirth: One of the most common causes of rectocele is vaginal childbirth. During delivery, the muscles and connective tissues in the pelvic area can become stretched or damaged, especially with large babies, prolonged labor, or the use of forceps. Multiple vaginal deliveries further increase the risk.
2. Aging and Menopause: As women age, particularly after menopause, the body’s production of estrogen decreases. Estrogen helps maintain the strength and elasticity of the pelvic tissues, and its decline can lead to weakening of these tissues, making a rectocele more likely.
3. Chronic Straining: Chronic straining due to constipation, heavy lifting, or chronic cough can put repeated pressure on the pelvic floor muscles, leading to their weakening over time. This straining can cause or exacerbate a rectocele.
4. Pelvic Surgery: Previous surgeries in the pelvic area, such as a hysterectomy (removal of the uterus), can weaken the support structures in the pelvis, increasing the risk of rectocele.
5. Genetic Predisposition: Some women may have a genetic predisposition to weaker connective tissues, making them more susceptible to developing a rectocele.
6. Obesity: Being overweight or obese can increase pressure on the pelvic floor, contributing to the development of rectocele.
7. Chronic Respiratory Conditions: Conditions that cause chronic coughing, such as chronic obstructive pulmonary disease (COPD), can also contribute to pelvic floor weakening.
8. Heavy Lifting: Frequent heavy lifting, especially without proper support or technique, can increase the risk of rectocele by putting excessive strain on the pelvic floor muscles.

Rectocele is more common in women who have had multiple vaginal deliveries, are postmenopausal, or have other risk factors that contribute to weakening of the pelvic floor. Addressing these risk factors, when possible, can help in the prevention or management of rectocele.

What is the treatment for rectocele?

Treatment for rectocele varies depending on the severity of the condition and the symptoms experienced. Non-surgical options are often the first line of treatment, especially for mild cases. Lifestyle changes, such as increasing fiber intake and staying hydrated, can help manage constipation and reduce the need to strain during bowel movements, which in turn can prevent the rectocele from worsening. Avoiding activities that involve heavy lifting or straining is also important in managing the condition.

Pelvic floor exercises, particularly Kegel exercises, can help strengthen the pelvic muscles and provide better support for the rectum. For some women, using a pessary—a removable device inserted into the vagina—can provide additional support for the pelvic organs and alleviate symptoms. Bowel management strategies, including the use of stool softeners or gentle laxatives, can also make bowel movements easier and reduce strain on the pelvic floor.

In cases where non-surgical methods are not effective or the rectocele is more severe, surgical treatment may be necessary. The most common surgical procedure is posterior colporrhaphy, which involves tightening and repairing the connective tissue and muscles between the vagina and rectum. In some cases, a synthetic mesh may be used to reinforce the vaginal wall, although this approach is controversial due to potential complications.

Transanal repair is another surgical option, though it is less commonly used and involves repairing the rectocele through the anus rather than the vagina. After surgery, patients typically require a recovery period and should avoid activities that could stress the surgical repair. Pelvic floor exercises may be recommended to help prevent recurrence, and regular follow-up care is important to monitor recovery and ensure that the rectocele does not return.

The choice of treatment should be made in consultation with a healthcare provider, considering the patient’s symptoms, lifestyle, and personal preferences. Non-surgical treatments may be sufficient for mild cases, while more severe cases often require surgical intervention to restore normal function and anatomy.