Rectocele

What is a rectocele?

A rectocele is a type of hernia (a bulging) of the wall of the rectum into the back of the vagina. You may even notice that it presses 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 of a rectocele is weakening of the tissues of the pelvis and vagina as a result of childbirth. The muscles and ligaments in the pelvis that hold up and support the female organs and vagina become stretched and weakened during labor and delivery. The more babies you have, the more the support tissues are stretched and weakened. Not everyone who has a baby will develop a rectocele. Some women have stronger supporting tissue in the pelvis and may not have as much of a problem as others. Women who have a Cesarean section usually do not get rectoceles.

Other conditions that can cause a rectocele include chronic constipation, a chronic cough, a lot of heavy lifting, obesity, and injury to the vagina. Older women may have this problem because the loss of female hormones causes the vaginal tissue to become weaker.

What are the symptoms?

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

• pelvic pressure in the rectal area
• protrusion of the lower part of the vagina through the opening of the vagina
• constipation and trapping of the stool, making it difficult to have a bowel movement (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

Since a rectocele is often found along with a weakened wall of the bladder known as a cystocele, you may also have bladder symptoms.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and will perform a pelvic exam. Your provider will ask you to bear down, pushing like you are having a bowel movement so he or she can see how big the bulge from the rectocele into the back of the vagina gets. Your provider will also ask you to contract the muscles of your pelvis (like you are stopping the stream in the middle of urinating) to determine the strength of your pelvic muscles. You may be examined in different positions: lying down, standing up, and squatting. You may also have a rectal exam.

How is it treated?

If you do not have any symptoms, no treatment may be necessary. Other treatment options include:

• Kegel exercises: Squeezing the muscles in your genital area may help strengthen your muscles and be of some help.
• Surgery: Surgical repair may be necessary. In some cases, a hysterectomy (removal of the uterus) may be recommended because the ligaments of the uterus are stretched and the uterus is falling down. Surgery is usually very effective and can be a lasting cure as long as you maintain a healthy lifestyle and weight.

A pessary, a small plastic or rubber ring that can be placed in the vagina, is sometimes used to help other pelvic support problems, but it will not help a rectocele.

How can I take care of myself?

You can take care of yourself by:

• treating and preventing constipation
• avoiding heavy lifting, and lifting correctly (with your legs, not with your waist or back)
• treating a chronic cough or bronchitis
• not smoking
• avoiding too much weight gain
• 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.