17415 Rectocele

Overview

A rectocele is when the wall of tissue between the rectum and the back wall of the vagina becomes weak. This can cause a bulge of the rectum into the vagina. It is one type of pelvic organ prolapse, which means one of the pelvic organs has slipped out of its usual place. It is not cancer and is not usually dangerous, but it can cause uncomfortable symptoms.

Yes, rectocele is quite common. It is especially common after vaginal childbirth, as the pelvic floor muscles and tissues can become stretched or damaged.

Rectocele affects people with a vagina. It most often occurs in women who have had a vaginal birth, are in their later years, have gone through the menopause, or have had a hysterectomy. Men with a rectum can also have a similar prolapse, but it is much less common in them.

Symptoms

Common symptoms

• Feeling of heaviness, fullness, or a bulge inside the vagina
• Difficulty moving your bowels, like the stool is getting blocked
• Needing to press on the vagina or perineum to help pass stool
• A pulling or aching feeling in the pelvis
• Discomfort during sex
• Feeling that you have not fully emptied your bowels

Symptoms in children

• Rectocele is very rare in children. If a child has constipation or a bulge in the genital area, it is more likely due to other causes and needs evaluation by a doctor.

Symptoms in older adults

• In older adults, symptoms may be more noticeable because the pelvic floor muscles become weaker with age.
• Constipation may be worse, and it may become harder to empty the bowel fully.
• Some older adults may mistake the bulge for a growth or worry about cancer, so it is important to see a doctor.

Causes

Main causes

• Weakening of the fascia (a sheet of tissue) that supports the rectum and vagina
• Stretching or tearing of the pelvic floor muscles and tissue during childbirth
• Increased pressure in the abdomen over time, such as from straining to pass stool, chronic coughing, or heavy lifting
• Loss of estrogen after menopause, which can thin and weaken the pelvic tissues

Risk factors

• Giving birth vaginally, especially multiple times or to a large baby
• Age — risk increases as you get older
• Obesity, which puts extra pressure on the pelvic floor
• Chronic constipation and straining on the toilet
• Repeated heavy lifting
• A prior hysterectomy
• A family history of pelvic organ prolapse

When to see a doctor

See a doctor urgently if:

• If you have sudden severe pain or find a painful bulge in the vagina or rectum
• If you cannot empty your bladder or bowels at all
• If you see bright red blood from the rectum or vagina that is new or heavy

Book a routine appointment if:

• If you have any of these symptoms and they bother you or affect your everyday life
• If you feel a bulge or a heavy, dragging feeling in the vagina
• If you find you need to press inside your vagina to pass stool
• If you have discomfort during sex or feel the symptoms getting worse

Diagnosis

A doctor will ask about your symptoms and then do a pelvic examination. You will usually lie on your back with your knees up. The doctor will insert one or two fingers into the vagina to feel the back wall. They may also look at the area while you lie down and sometimes while you stand or push down, as if you are having a bowel movement.

Tests that may be done

• Pelvic examination, which is the main way to diagnose a rectocele
• A rectovaginal examination, where the doctor checks the wall between the vagina and rectum
• An ultrasound to look at the pelvic organs, if needed
• A magnetic resonance imaging (MRI) scan, if the diagnosis is not clear
• A defecography, which is a special X-ray that shows how your rectum empties when you pass stool

What to expect at your appointment

The examination is usually quick. You may be asked to bear down or push, and the doctor might measure the size of the bulge. It may feel a little uncomfortable, but it should not be painful. The doctor will explain what they find and talk through your options with you.

Treatment

Treatment for a rectocele depends on how much it is affecting your life. If you have no symptoms or only mild symptoms, you may not need any treatment. If it is causing discomfort, there are a number of nonsurgical options to try first. The goal is to improve your symptoms and quality of life.

Self-care at home

• Eat a high-fibre diet to soften your stool and make it easier to pass
• Drink plenty of water during the day
• Do pelvic floor exercises to strengthen your pelvic muscles
• Avoid straining on the toilet
• Maintain a healthy weight
• Avoid very heavy lifting, or lift in a safe way

Medical treatments

If lifestyle changes are not enough, a healthcare professional may suggest a vaginal pessary. This is a small ring made of soft medical silicone that is fitted inside the vagina to support the tissue. It is not a medication, but a support device. Some people also benefit from a course of pelvic floor physiotherapy, which helps you do exercises properly. If you are past the menopause, doctors may talk about oestrogen cream, but it is not suitable for everyone. A doctor or nurse will always explain any product or treatment and check if it is right for you. No specific brand or drug is recommended here.

When is surgery considered?

Surgery might be considered if symptoms are severe and do not improve with other measures. Surgery aims to repair the weakened tissue and lift the rectum back into place. It is a personal decision to make with your doctor after discussing the benefits and risks.

Living with this condition

Living with a rectocele often means making small adjustments, like going to the toilet when you feel the urge and not sitting for too long. You may find it helpful to pause and breathe instead of holding your breath when passing stool. If you use a pessary, you will need regular check-ups to make sure it fits well and is comfortable.

Lifestyle tips

• Talk to your healthcare provider before starting a new exercise routine
• Avoid high-impact exercises that put a lot of pressure on the pelvic floor, like jumping or running
• Learn to lift correctly: bend at your knees, not your back, and don't lift more than is comfortable
• Eat a healthy, balanced diet to prevent constipation
• Try to see the condition as something you can manage, not something you have to hide

Diet and exercise

A balanced diet rich in fruit, vegetables, and whole grains helps keep your stools soft. Drink about six to eight glasses of water a day. Regular, gentle exercise like walking, swimming, and cycling can also help, and pelvic floor exercises are especially helpful. Avoiding straining is one of the most important things you can do.

Mental health and emotional wellbeing

It is common to feel embarrassed, frustrated, or anxious about having a rectocele. You may worry about intimacy or feel that others can tell. These feelings are valid, and you are not alone. Remember that this is a medical condition, not something to be ashamed of. Many people find that talking to a trusted friend or a healthcare professional helps.

Prevention

It is not always possible to prevent a rectocele, but you can reduce your chances by avoiding constipation, doing pelvic floor exercises, maintaining a healthy weight, and avoiding heavy lifting. After childbirth, pelvic floor physiotherapy may also help strengthen the muscles.

Screening programmes

There is no routine screening test for rectocele. If you have risk factors or bothersome symptoms, talk to a doctor. They can assess whether you need a pelvic examination.

Complications

If left untreated

• Constipation may become chronic and lead to haemorrhoids or an anal fissure
• The bowel may become harder to empty completely
• In rare cases, the rectal tissue may become trapped (incarcerated) and reduce blood flow, which is a medical emergency
• The skin of the vaginal wall may become ulcerated or infected if it rubs on clothing or if the bulge is very large

Long-term outlook

With the right treatment and lifestyle changes, most people with a rectocele feel much better. It is not a life-threatening condition, and for many people it never causes severe problems. Surgery, when needed, usually has good results. This is a treatable condition, and you are not alone — talking to a healthcare professional is the first step to improvement.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.