Rectocele

A rectocele happens when the tissue between your rectum and vagina weakens, causing your rectum to bulge onto your vagina’s back wall. It’s also called posterior vaginal wall prolapse.

Your rectum is the bottom part of your colon (large intestine). Your pelvic floor muscles typically keep your rectum and vagina in place. When your pelvic floor weakens, these organs can shift and even fall onto each other.

Rectocele is one form of pelvic organ prolapse (POP). Often, it happens with other forms of POP, like uterine prolapse and fallen bladder.

Rectoceles aren’t life-threatening, but they can decrease your quality of life. Know that you have a few treatment options that can help fix it.

Symptoms of rectocele

Symptoms of a rectocele include:

• A soft bulge of tissue you can feel in the back wall of your vagina.
• Feeling that your rectum hasn’t completely emptied after pooping.
• Having to press your fingers on the bulge in your vagina to push out poop (“splinting”).
• Leakage of poop without control (fecal incontinence).
• Looseness or loss of muscle tone in your vagina.
• Painful intercourse (dyspareunia).
• Pressure or fullness in your rectum or vagina.
• Urgency to poop several times a day (fecal urgency).

Rectoceles don’t always cause symptoms. When they do, they’re usually more unpleasant or uncomfortable than painful. Still, it’s important to talk to your gynecologist or primary care provider if you think you may have a rectocele.

Rectocele causes

A rectocele happens when your pelvic floor weakens. Several factors can contribute to this. The most significant risk factors include:

• Repeated pregnancies and births. Having many pregnancies and births can weaken your pelvic floor muscles over time. You’re especially susceptible to rectoceles if you’ve had five or more births (high parity).
• Vaginal delivery. Vaginal childbirth can damage or weaken your pelvic floor. The use of forceps or vacuum during delivery, tearing and episiotomy all increase your risk.
• Aging. Your pelvic floor tends to weaken over time. Hormone changes in menopause can lead to decreased muscle tone in your pelvic region.
• Obesity. Carrying excess weight can strain your pelvic floor muscles.
• Chronic constipation. Constantly straining to poop can put a lot of pressure on your pelvic floor muscles.

Other risk factors include chronic cough or bronchitis and repeated heavy lifting.

How doctors diagnose this condition

Gynecologists can often diagnose a rectocele by asking about your medical history and doing a pelvic exam. In addition to examining your vaginal canal for signs of prolapse, your provider may test your pelvic floor strength during the exam.

They may ask you to squeeze and relax your pelvic floor muscles as if you were stopping a stream of pee. They may also ask that you apply pressure to your gut or strain as if you were pooping. Doing this makes the prolapse more visible.

Your provider may use a grading or staging scale to describe the severity of the rectocele based on the pelvic exam.

In rare cases, your provider may recommend a transvaginal ultrasound to check if your small intestine has prolapsed (enterocele). They may also recommend a special X-ray or an MRI called a defecography. It shows the changes in your rectum when you poop. It can reveal how severe a rectocele is.

How do you fix a rectocele?

Healthcare providers typically recommend nonsurgical management first to fix a rectocele, especially if you have a mild one. For moderate to severe prolapse, your provider may recommend surgery to repair it.

Nonsurgical management

Nonsurgical management strategies include:

• Pelvic floor exercises. These exercises (like Kegels) can strengthen your pelvic floor muscles. A physical therapist who specializes in pelvic floor therapy can guide you.
• Preventing constipation and straining. Your provider may recommend increasing the amount of fiber you consume and drinking more water. They may also recommend a stool softener.
• Vaginal pessary. This is a removable device you insert into your vagina to support prolapsed organs.

Surgery

If conservative treatment isn’t enough to resolve your symptoms, surgery is the next option. You and your provider will discuss the following to determine the right procedure:

• Your age and general health
• The degree of your prolapse
• Your desire for future pregnancies
• Your wish to continue having vaginal intercourse (one surgery for POP called colpocleisis seals your vaginal opening)

A common surgery for rectoceles is called posterior colporrhaphy. Your surgeon removes damaged tissue that’s no longer supporting your pelvic organs. They suture (stitch) the healthy tissue together for added support.

Often, surgeons perform rectocele surgery through your vagina — an approach that leaves no scars.

When should I see my healthcare provider?

If your symptoms get worse or your treatment plan doesn’t seem to be working, let your healthcare provider know.

It may be helpful to ask your provider the following:

• What lifestyle changes may ease my symptoms?
• How can I prevent my rectocele from getting worse?
• How can I prevent other forms of pelvic organ prolapse?
• Would you recommend surgery? If so, what are the risks?
• What are the success rates for the type of surgery you’d recommend?
• Will treatment negatively impact my sex life in any way or my chances of pregnancy?

Can I prevent a rectocele?

You can’t always prevent a rectocele or pelvic organ prolapse. But many practices can help strengthen your pelvic floor. You can use many of the management strategies for rectocele to reduce your risk of prolapse. This includes regular pelvic floor exercises and avoiding constipation.

What can I expect if I have this condition?

Your outlook depends on your symptoms and how severe the prolapse is. Most people who receive surgery for rectocele experience symptom relief after the procedure.

Talk to your healthcare provider about your outlook based on the treatments they recommend for you.

What happens if rectocele isn’t treated?

Rectocele may worsen without treatment and lifestyle adjustments. Your symptoms may get worse over time, further impacting your quality of life.

Can poop get stuck in a rectocele?

Yes. With severe prolapse, poop can become trapped in the pocket of the rectocele. This prevents poop from passing easily.

In this case, you may have to try splinting to pass a stool. Splinting involves putting your finger in your vagina and pressing against the rectocele to nudge the poop out. Ensure that your finger is clean (bacteria-free) before inserting it into your vagina. Wash with mild soap and water.

Talk to your healthcare provider about treatment options if you have to use your fingers to have a bowel movement.

Is a rectocele a hernia?

A rectocele is like a hernia, in that your rectum bulges (herniates) into your vaginal wall. But healthcare providers classify rectoceles as a type of pelvic organ prolapse, not a hernia.