What Is a Rectocele?
A rectocele happens when the supportive tissue between the vagina and rectum weakens, causing the front wall of the rectum to bulge into the back wall of the vagina.
A rectocele isn't the same as a rectal prolapse. In a rectal prolapse, the rectum bulges through the anus rather than through the vaginal wall.
Women are more likely to develop a rectocele than men, though a small percentage of men can develop one following prostate removal as a treatment for prostate cancer. A rectocele is most often seen in older women after multiple vaginal births.
When a rectocele is small, it often doesn't cause symptoms and doesn't need treatment. Certain lifestyle modifications can help maintain the condition and slow its progression. Rectoceles typically need treatment only once they start to interfere with quality of life.
Definition: A rectocele is the bulging of the rectum into the posterior (back) wall of the vagina.
Causes
- Traumatic vaginal delivery: tears or an episiotomy (surgical incision) can extend toward the rectum
- Weak pelvic floor muscles and weakening of the tissue between the rectum and vagina
- A history of constipation involving chronic straining
- Rectal surgeries
- Pelvic surgeries, such as a hysterectomy
Diagnosis
A rectocele can be detected during a physical pelvic exam by a gynecologist, colorectal surgeon, or urogynecologist. Further testing may be done to assess severity more accurately, such as defecography, a specialized X-ray that shows changes in the rectum and anal canal during a bowel movement. This test can help determine the degree of prolapse and the extent of bowel emptying.
Treatment
Treatment can be surgical or non-surgical, depending on the severity of the rectocele.
- Non-surgical treatment: mild cases can often be treated with remedies like bowel retraining
- Surgical treatment: considered when non-surgical treatments don't resolve symptoms that continue to interfere with quality of life. Surgery aims to strengthen the wall between the vagina and rectum. Posterior colporrhaphy is the surgical procedure used to repair a rectocele.
Physical Therapy
Pelvic floor exercises are an effective way to strengthen the pelvic floor muscles, helping to maintain function and prevent a rectocele from worsening. When a pelvic organ prolapse is noted, it can often be managed at home depending on its degree, with consistent, regular practice of the exercises and lifestyle guidance your therapist recommends.
Conclusion
- A rectocele occurs when the rectum bulges through the posterior wall of the vagina
- Mild cases of prolapse can often be treated successfully without surgery
- Pelvic physical therapy can be an effective way to manage mild degrees of prolapse
Rectocele is one type of pelvic organ prolapse. Learn more about our approach to pelvic organ prolapse and pelvic floor therapy, or request an appointment to talk with Dr. Kavitha directly.