Rectocele

What is a rectocele?

Ligaments, muscles, and connective tissue normally hold your rectum and other organs in their proper places in your pelvis. When these tissues get weak, one or more of the organs in the pelvic area of your body may press into or drop down into the vagina. When the rectum presses into the vagina, it is called a rectocele. The rectum may press against the vaginal wall so much that some vaginal tissue sticks outside of the opening of your vagina.

How does it occur?

The most common cause is weakening of the tissues of the pelvis and vagina after childbirth. This can happen because the muscles and skin of the birth canal (vagina) are stretched and sometimes torn during childbirth. They heal over time but may not be as strong as they were before.

Older women may have this problem because the loss of female hormones after menopause weakens the vaginal walls.

A rectocele may also be caused by:

• chronic constipation
• a chronic cough
• a lot of heavy lifting
• obesity
• injury to the vagina.

What are the symptoms?

You may not have any symptoms. If you do have symptoms, they may include:

• a feeling of pressure in the rectal area
• trouble having bowel movements (in severe cases, you may have to press on the lower part of your vagina to help push the stool out of your rectum)
• leaking of bowel movement

You may feel tissue sticking out of the opening of the vagina.

The bladder may also press into the vagina. This problem is called a cystocele. It may cause bladder symptoms. For example, you may have problems with repeat bladder infections or a leaking of urine.

How is it diagnosed?

Your healthcare provider will ask about your symptoms. You will have a pelvic exam. Your provider may ask you to bear down and push as you would to have a bowel movement. This will help your provider see how much the rectocele bulges into the back of the vagina. Your provider may also ask you to squeeze the muscles of your pelvis (as you would to stop urinating) to check the strength of your pelvic muscles. You may be examined in different positions: lying down, standing up, and squatting. You will also have a rectal exam.

How is it treated?

You may not need treatment if you do not have any symptoms. Treatment options may include:

• Kegel exercises: These are exercises you can do to strengthen the muscles in and around your vagina. They are done by squeezing the pelvic floor muscles on a regular schedule.
• Surgery: You may need surgery to repair weakened tissue. In some cases, a hysterectomy (removal of the uterus) may be recommended because the ligaments of the uterus are stretched and the uterus is also falling into the vagina.

How long will the effects last?

Doing Kegel exercises every day may be all that you need to do to relieve symptoms caused by the rectocele. Kegel exercises are usually recommended before surgery is considered. Talk to your healthcare provider about whether she or he thinks nonsurgical treatments will be helpful for you.

Surgery is usually very effective and can be a lasting cure as long as you have a healthy lifestyle and weight. However, later on the tissues could stretch and weaken again.

How can I take care of myself or prevent a rectocele?

You can take care of yourself by:

• treating and preventing constipation
• avoiding heavy lifting
• lifting correctly (with your legs, not with your waist or back)
• treating a chronic cough
• not smoking
• keeping a healthy weight
• doing Kegel exercises, especially after you have a baby

If you are concerned about the effects of childbirth on your pelvic tissues, discuss it with your healthcare provider before delivery.