What is Rectocele?

A rectocele is a bulge of the front wall of the rectum into the vagina. The rectal wall may become thinned and weak, and it may balloon out into the vagina while trying to push down to have a bowel movement.

What Can Cause a Rectocele?

The underlying cause of a rectocele is a weakening of the pelvic support structures.

Risk factors include multiple, difficult or prolonged deliveries, the use of forceps or other assisted methods of delivery, constipation and straining with bowel movements.

What are the Symptoms of Rectocele?

Symptoms may be primarily vaginal or rectal.

Vaginal symptoms- vaginal bulging, sensation of a mass in the vagina, pain with intercourse or vaginal bleeding.

Rectal symptoms- constipation, urge to bowel movement after leaving the bathroom because stool that was trapped in the rectocele may return to the low rectum after standing up. Feeling of pressure or discomfort is often present.

How is Rectocele Diagnosed?

Most rectoceles may be identified on a routine clinical examination of the vagina and rectum. Accurate method of assessing the rectocele is an x-ray study called a defecagram which shows size of the rectocele and if it empties with evacuation.

What Treatment is Available for a Rectocele?

Rectoceles that are not causing symptoms do not need to be treated. In general constipation is to be avoided by high fiber diet and plenty of oral fluids.

Medical Treatment

  • High fiber Dietand 6 to 8 glasses of fluids each day

  • Fiber supplement / stool softener

  • Laxatives are best avoided in most cases.

  • Avoid prolonged straining, if you cannot completely empty, get up and return later. Holding pressure with a finger to support the rectocele and encourage the stool to go in the correct direction is often helpful.

  • Avoid placing a finger inside the anus to pull the stool out as this may cause harm.

  • A pessary may be used to support the pelvic organs.

Surgical Treatment

If symptoms persist even with medical therapy, then surgical repair may be indicated. Repair may be performed through the anus, vagina, perineum between the anus and vagina, or abdomen.

If the symptoms are entirely vaginal, then gynecologist may address the problem. If symptoms are rectal, then a colorectal surgeon should be involved.

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