Rectocele

Definition
A rectocele occurs when a herniation of the front wall of the rectum extends into the back wall of the vagina. The tissue between the rectum and vagina can become weaker and thinner over time, which can increase risk for development of a rectocele. If the rectocele is very small, there may be no noted symptoms.

Causes
Generally, the cause of a rectocele is not known, but most are concurrent with weakening of the pelvic floor. A weakened pelvic floor has may possible causes, including aging, childbirth, and trauma that is sustained during childbirth. Additional causes may include chronic constipation and multiple gynecological or rectal surgeries.

Risk Factors
Risk factors for the development of a rectocele are varied. Women who have had multiple vaginal deliveries, trauma during childbirth (episiotomy, forceps delivery, vacuum delivery, tearing during vaginal delivery), and women who experience chronic constipation are at risk for developing a rectocele.  

Symptoms
If patients experience symptoms from a rectocele, the symptoms could be either vaginal or rectal, and will vary. Some symptoms may include:

  • Rectal discomfort
  • The urge to have several bowel movements a day
  • Fecal incontinence
  • Difficulty with full evacuation during a bowel movement
  • A feeling of fullness in the vagina
  • Tissue that extends outside the vagina
  • Discomfort during sexual intercourse
  • Vaginal bleeding

Treatments
Conservative treatment options for a rectocele will generally be considered first. This may include a high fiber diet (25+ grams of fiber per day or more) and an increase of water consumption. This combination should promote softer stool, which will reduce the risk of straining during a bowel movement. If this combination does not work, stool softeners may also be recommended.

If these conservative methods do not sufficiently reduce symptoms, surgery may be required to repair the rectocele. Surgery should only be considered if symptoms are affecting daily life and making general activities difficult. The goal of surgery will be to remove the rectocele and reinforce the tissue between the rectum and vagina to prevent the development of recurrent rectoceles.