A rectocele is a condition where weakened tissues in your pelvis cause your rectum to sag onto your vaginal wall. It’s a form of pelvic organ prolapse. If the bulge (prolapse) is small, you may not notice symptoms. With a more significant prolapse, your rectum may protrude out of your vagina. In severe cases, you may need surgery to repair the rectocele.
A rectocele is a condition where the tissue between your rectum and vagina weakens, causing your rectum to bulge onto your vagina's back wall. Your rectum is the bottom part of your colon (large intestine). Both your rectum and vagina stay in position because the muscles and ligaments in your pelvis, called your pelvic floor, hold them 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), a condition where organs droop because of a weak pelvic floor. Often, rectocele happens with other forms of pelvic organ prolapse, where organs like your uterus or bladder shift out of place, too.
Rectocele is also called posterior vaginal wall prolapse.
Rectoceles are most commonly diagnosed in people assigned female at birth who are over 60. Still, you can get a rectocele no matter your age or gender.
Rectoceles are common, probably even more than we know. Minor rectoceles often don't cause symptoms, which means that many people likely never visit their providers for this complaint or receive a diagnosis.
Rectoceles don't always cause symptoms. When they do, they're usually more unpleasant or uncomfortable than painful.
Signs of a rectocele include:
If you have a rectocele along with another form of prolapse where your bladder sags, you may also experience urinary incontinence. You may feel the urge to pee frequently, or you may dribble.
A rectocele occurs when your pelvic floor weakens. Several factors can contribute:
Gynecologists can often diagnose a rectocele with a thorough medical history and physical exam.
Diagnosis may include:
Mild rectoceles may be managed with pelvic floor exercises to strengthen your pelvic floor muscles. Your healthcare provider may also recommend a pessary. A vaginal pessary is a removable device inserted into your vagina to support prolapsed organs.
With moderate to more severe prolapse, your healthcare provider may recommend surgery to repair the rectocele. You may discuss the following with your provider to determine the right procedure:
A surgical procedure called posterior colporrhaphy is commonly used to repair rectoceles. During the procedure, your provider removes damaged tissue that's no longer supporting your pelvic organs and sutures the healthy tissue together for added support.
Often, your provider performs rectocele surgeries through your vagina, an approach that leaves no scars.
You can't prevent a rectocele or pelvic organ prolapse. Still, you can put good practices into place that can strengthen your pelvic floor. Many of the same strategies used to manage mild cases of rectocele can be used to reduce your risk of prolapse.
Your outlook depends on your symptoms and how severe your prolapse is. Most people who receive surgery for rectocele experience symptom relief after their procedure.
Speak with your provider about the outlook for your rectocele based on the treatments they recommend for you.
No. A rectocele occurs because of injury or long-term weakening of your pelvic floor. It doesn't heal on its own without treatment.
Rectocele can worsen without treatment. Not every rectocele requires surgery. Still, depending on the severity of your rectocele, you may need to increase your fiber intake, perform daily Kegel's, use a pessary, etc. Follow the treatment plan that you and your provider decide works best.
With severe prolapse, you may need to use your fingers to hold your vaginal wall up so that you can poop. This process is called "splinting." You may have to use a finger 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.
When prolapse is this severe, it's a good idea to speak to your provider about treatment options.
Yes. With severe prolapse, stool can become trapped in the pocket formed by the rectocele, preventing stools from passing easily. In this case, you may have to try splinting to pass a stool. Talk to your provider about treatment options if you have to use your fingers to have a bowel movement.
Your rectocele may be so slight that you can't feel it. If the prolapse is more pronounced, it may feel like a bulge or lump in the back wall of your vagina. You can insert a (clean) finger or two to feel for a rectocele. Place pressure on the back part of your vaginal wall so that you're pressing the tissue closest to your rectum. Bulging tissue in this area is a sign of a rectocele.
Both rectocele and cystocele are conditions that involve pelvic organs shifting out of place because of a weakened pelvic floor. With a rectocele, weaknesses in the pelvic floor cause the rectum to bulge onto your back vaginal wall. With a cystocele, weaknesses cause your bladder to bulge onto the front vaginal wall. These types of prolapse sometimes happen together, along with other forms of pelvic organ prolapse.
A note from Cleveland Clinic
Having a prolapsed organ can feel both uncomfortable and embarrassing. This is especially the case with a rectocele, which can make it harder to poop. Speak to your provider if you notice the symptoms of a pelvic organ slipping. Rectoceles and other forms of prolapse are common. Many people manage them through lifestyle changes. This may be an option for you, too. If the prolapse is more severe, your provider can recommend surgeries that can help.
Last reviewed by a Cleveland Clinic medical professional on 03/22/2022.
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