What is Rectocele?
Rectocele is a condition where the rectal wall bulges into the back wall of the vagina due to weakening of the supporting tissues. It occurs when the rectovaginal septum (the tissue between the rectum and vagina) becomes thin or stretched, often leading to discomfort, a sensation of pressure, or difficulty with bowel movements. This condition is a type of pelvic organ prolapse and is more common in women, particularly after childbirth or menopause.
What Causes Rectocele?
Several factors can weaken the pelvic floor and contribute to rectocele, including:
- Vaginal childbirth, especially with large babies or multiple deliveries
- Chronic constipation and repeated straining during bowel movements
- Aging and loss of tissue elasticity
- Menopause and reduced estrogen levels
- Heavy lifting or high-impact physical activity over time
- Prior pelvic surgery or trauma
- Obesity or being overweight
- Genetic predisposition to weak connective tissues
What Are the Symptoms of Rectocele?
Symptoms can vary from mild to severe and may include:
- A bulging sensation or fullness in the vagina
- Feeling of pressure in the pelvic area
- Difficulty emptying the bowels completely
- Needing to press on the vaginal wall to help with bowel movements (splinting)
- Vaginal discomfort or pain, especially during intercourse
- Constipation or frequent straining
- Visible tissue bulge at the vaginal opening in severe cases
How Is Rectocele Diagnosed?
Diagnosis typically involves a physical exam and possibly imaging tests to confirm the extent of the prolapse:
- Pelvic examination to assess the degree of bulging
- Defecography (X-ray during bowel movement) to evaluate rectal function
- MRI or pelvic ultrasound for detailed pelvic floor imaging
- Urodynamic tests if urinary symptoms are also present
- Medical history including childbirth, bowel habits, and symptom progression
What Are the Treatment Options for Rectocele?
Treatment depends on the severity of the condition and how much it affects daily life:
- Lifestyle modifications: High-fiber diet, hydration, avoiding straining, and weight management
- Pelvic floor exercises: Kegel exercises to strengthen supporting muscles
- Pessary device: A removable device inserted into the vagina to support the prolapsed area
- Medications: Laxatives or stool softeners to reduce constipation
- Surgical repair: Recommended for severe cases or when other treatments fail. Surgical options include:
- Posterior colporrhaphy to tighten the rectovaginal wall
- Robotic or laparoscopic procedures for minimally invasive repair
- Combined procedures if other pelvic organs are also prolapsed
Can Rectocele Cause Complications?
If left untreated, rectocele may lead to:
- Chronic constipation and straining
- Rectal or vaginal pain
- Difficulty with sexual intercourse
- Worsening pelvic organ prolapse (involving bladder or uterus)
- Impact on quality of life and emotional well-being