Vaginal Prolapse Rectocele

What is a rectocele?

A rectocele is a condition in which the wall of tissue that separates the rectum from the vagina is weakened, allowing the vaginal wall to budge. Commonly, the front wall of the rectum bulges against the posterior of the vagina. The size of the prolapse often indicates if it is symptomatic. If the prolapse is small they can be asymptomatic (no symptoms). Larger prolapses however, may create a noticeable bulge through the vaginal opening. In severe cases, surgery is recommended for repair of the rectocele.

What are the symptoms of a rectocele?

This shows the rectum which has been herniated into the vagina.

A small posterior prolapse may cause no signs or symptoms. Otherwise, you may notice:

  • A soft bulge of tissue in your vagina that may or may not protrude through the vaginal opening
  • Difficulty having a bowel movement with the need to press your fingers on the bulge in your vagina to help push stool out during a bowel movement ("splinting")
  • Sensation of rectal pressure or fullness
  • A feeling that the rectum has not completely emptied after a bowel movement
  • Sexual concerns, such as feeling embarrassed or sensing looseness in the tone of your vaginal tissue
  • Many women with posterior prolapse also experience prolapse of other pelvic organs, such as the bladder, uterus or small intestine.

When a posterior prolapse is small, you don't need medical care. Posterior prolapse is common, even in women who haven't had children. In fact, you may not even know you have posterior prolapse. If you experience unusual symptoms like the ones listed above, it is a good idea to schedule a visit with your physician.

What causes rectocele?

There are several factors that contributes to the occurrence of rectocele.

  • Pregnancy and childbirth
  • Chronic constipation or straining with bowel movements
  • Chronic cough or bronchitis
  • Repeated heavy lifting
  • Being overweight or obese

Vaginal childbirth, especially multiple births and aging are the primary risk factors. Prolonged labor and large children can stretch and weaken pelvic floor muscles leading to weakened support for the vagina. This does not happen in all women but does happen in many who may not recover completely from the birthing process. Menopause initiates a host of changes in a woman’s body, which can affect pelvic region muscle tone.

Aging in general weakens muscles throughout the body including the pelvic region. Other factors such as obesity and chronic coughing associated with asthma, smoking and respiratory disease are also associated with weakening these muscles. Chronic constipation and bearing down to expel waste can weaken pelvic muscles.

Women without symptoms are often diagnosed with the problem during routine gynecological examinations. Symptomatic women are also usually diagnosed by their gynecologist. Physicians who specialize in gynecology can typically diagnose it with a thorough medical history and physical exam. Laboratory testing or imaging studies are rarely needed.

These physical examinations include a bladder function test and a pelvic floor strength test.

Pelvic floor strength test: During the pelvic examination, the doctor tests the strength of the pelvic floor, the sphincter muscles, and muscles and ligaments that support the vaginal walls, uterus, rectum, urethra, and bladder. Irregularities in this test can help diagnose vaginal prolapse and determine if kegel exercises would be helpful to the patient.

Bladder function test: Otherwise known as urodynamics, bladder function tests determine the ability of the bladder to store and eliminate urine. This is measured two ways. Uroflowmetry measures the volume and force of the urine stream. Cystometrogram is a procedure which fills the bladder with water via catheter. Measurements of volume are noted when the patient indicates urgency of urination.

How is rectocele treated?

If conservative measures fail, your physician may recommend surgery to help fix vaginal prolapse. When you meet with your surgery specialist, you may discuss your age and general health, desire for future pregnancies, wish to preserve vaginal function, the degree of prolapse and anatomic conditions that affect decisions as to which surgical procedure to pursue. For instance, a hysterectomy (removal of the uterus) may be required when significant prolapse is present.

There are two primary approaches depending on the condition. Many surgeries are conducted through the vagina, an approach that leaves no scars, while laparoscopy is an increasingly sought after method of repairing prolapse. These surgical procedures are conducted through narrow tubes inserted through incisions less than an inch long. These procedures have been shown to reduce scarring, blood loss, and hospital stays, and speed recovery times.

A surgical procedure called anterior colporrhaphy tightens the front walls of the vagina, while posterior colporrhaphy tightens the back walls. Laparoscopic procedures are employed to relieve stress incontinence, repair hernias at the top of the vagina, and to create support for vagina’s that have become weakened by a hysterectomy. In instances in which supporting tissues have been weakened, additional natural tissue or artificial materials (mesh) may be placed to support the repair.

Hospitalization is brief, usually a day, sometimes two and seldom more than four. Patients are released with prescriptions for pain killers and antibiotics to prevent infection.

Can rectocele be prevented?

In most cases vaginal prolapse is unpreventable. However, if you address risk factors before they become problematic, it can help your vaginal health.

  • Perform Kegel exercises on a regular basis. These exercises can strengthen your pelvic floor muscles — especially important after you have a baby.
  • Treat and prevent constipation. Drink plenty of fluids and eat high-fiber foods, such as fruits, vegetables, beans and whole-grain cereals.
  • Avoid heavy lifting and lift correctly. When lifting, use your legs instead of your waist or back.
  • Control coughing. Get treatment for a chronic cough or bronchitis, and don't smoke.
  • Avoid weight gain. Talk with your doctor to determine your ideal weight and get advice on weight-loss strategies, if you need them.

Reviewed by a Cleveland Clinic medical professional.

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