Rectocele

Overview

A rectocele is a condition where the wall between the rectum (the last part of the bowel) and the vagina weakens, allowing the rectum to bulge into the vagina. It is a type of pelvic organ prolapse.

Yes, it is fairly common, especially in women who have had children or are past menopause. Many women have a mild rectocele without knowing it.

It mainly affects women, especially those who have given birth vaginally, have had a hysterectomy, or are older. It is rare in men.

Symptoms

Common symptoms

• A feeling of fullness or pressure in the vagina
• A bulge of tissue coming out of the vagina
• Trouble passing stool (constipation) or a feeling that you can't empty your bowels completely
• Needing to press on the bulge or inside the vagina to help stool come out (called splinting)
• Pain or discomfort during sex
• Lower back pain

Symptoms in children

• Rectocele is very rare in children; if suspected, it may be related to birth defects or injury.

Symptoms in older adults

• Symptoms may be more noticeable after menopause due to lower estrogen levels weakening the pelvic floor.
• Constipation and the need to splint are common concerns.
• Older women may also have prolapse of other pelvic organs like the bladder or uterus.

Causes

Main causes

• Weakening of the pelvic floor muscles and connective tissue that support the vagina and rectum
• Stretching or injury during vaginal childbirth
• Chronic constipation or straining on the toilet for years
• Repeated heavy lifting
• Being overweight or obese
• Declining estrogen levels after menopause

Risk factors

• Having given birth vaginally, especially multiple times or to a large baby
• Age (risk increases after menopause)
• Chronic constipation or lung diseases that cause frequent coughing
• Prior pelvic surgery (e.g., hysterectomy)
• Genetics – some families have weaker connective tissues

When to see a doctor

See a doctor urgently if:

• If you have new, severe pain in your pelvis or rectum
• If you notice a bulge that becomes hard, swollen, or very painful

Book a routine appointment if:

• If you feel a bulge in your vagina that bothers you
• If you have ongoing trouble passing stool, or need to splint regularly
• If you have discomfort during sex or pressure that affects daily life

Diagnosis

A doctor (usually a gynecologist or a colorectal specialist) will ask about your symptoms and do a pelvic exam. They may also ask you to bear down or cough while feeling inside your vagina to see how the rectocele moves.

Tests that may be done

• Pelvic examination (with speculum and while lying down)
• Dynamic pelvic MRI (to see the organs during bearing down)
• Defecography (a special X-ray while you pass stool-like material) – less common now
• Sometimes a bladder or bowel function test

What to expect at your appointment

The exam is usually quick and painless. The doctor will gently check inside your vagina and rectum. You may feel some pressure, but it should not be painful. If further tests are needed, they will explain them.

Treatment

Treatment depends on how much the rectocele bothers you. If symptoms are mild, you may only need lifestyle changes and exercises. For more bothersome symptoms, there are non-surgical and surgical options.

Self-care at home

• Do pelvic floor muscle exercises (Kegels) daily to strengthen the muscles that support the pelvic organs
• Avoid heavy lifting and straining when using the bathroom
• Eat a high-fiber diet and drink plenty of water to prevent constipation
• Maintain a healthy weight
• Use a vaginal pessary (a silicone device that supports the bulge – fitted by a healthcare provider)

Medical treatments

If self-care isn't enough, a doctor may suggest a pessary (a ring or device placed in the vagina to hold the bulge back). They can show you how to clean and insert it. Some women benefit from estrogen cream or tablets (applied vaginally) to strengthen the tissue, but this is only for women after menopause. Never use any medication without a doctor's advice.

When is surgery considered?

Surgery is considered if symptoms are severe and other treatments haven't helped, or if you can't tolerate a pessary. The operation repairs the wall between the rectum and vagina, often through the vagina. Talk to your surgeon about the risks and recovery time.

Living with this condition

With a rectocele, you can still do most everyday activities. Avoid heavy lifting and high-impact exercises that strain the pelvic floor. Use good posture and take your time on the toilet. Most women manage well with lifestyle changes and support.

Lifestyle tips

• Take stool softeners or fiber supplements if needed (ask your pharmacist or doctor)
• Don't push or strain during bowel movements – relax and let things happen naturally
• If you need to splint, do it gently with clean hands
• Try not to sit on the toilet for long periods

Diet and exercise

Eat plenty of fruits, vegetables, whole grains, and legumes to keep stools soft. Drink 8-10 glasses of water a day. Exercise regularly, but focus on core and pelvic floor exercises. Avoid jumping, running, or heavy weightlifting without advice from a physio.

Mental health and emotional wellbeing

It's normal to feel embarrassed or worried about a rectocele. It can affect your body image and intimacy. Talk to your partner or a counselor if you feel down. Remember: this is a medical condition, not your fault.

Prevention

You can lower your risk by avoiding chronic constipation, not straining on the toilet, doing regular pelvic floor exercises, maintaining a healthy weight, and using proper lifting techniques. After childbirth, ask about pelvic floor rehab.

Complications

If left untreated

• Worsening bulge that may eventually come out of the vagina (prolapse) and cause ulceration or bleeding
• Severe constipation that becomes hard to manage
• Difficulty emptying the bladder if it's also prolapsed
• Pain during sex that affects relationships

Long-term outlook

For most women, a rectocele can be managed well without surgery. With treatment, symptoms often improve. Even if surgery is needed, results are usually good, and women can return to normal activities. It's a treatable condition, so you don't have to suffer in silence.

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