What is a rectocele?

A rectocele is a type of prolapsed pelvic organ. It occurs in the pelvic floor when the supporting ligaments and muscles weaken. Some terms for a rectocele are a prolapse or a proctocele in the posterior vaginal wall.

Childbirth, age, and a number of other factors can lead to weakening of the normally strong, fibrous, sheet-like divider between rectum and vagina.

At a period of straining, such as a bowel movement, a bulge can protrude into the back of the vagina as a hernia.

A rectocele may lead to constipation and discomfort but there may be no symptoms if it is low.

Many people may treat a rectocele at home, but can need surgery in a serious case.

Types

A rectocele happens when the pelvic floor weakens. It can lead to constipation.
A rectocele happens when the pelvic floor weakens. It can lead to constipation.

A rectocele is one form of prolapse in pelvic organ. In a woman, the rectum sprouts through the vagina’s back wall.

Certain causes of prolapse include:

  • anterior vaginal wall prolapse, or cystocele, where the urinary bladder bulges into the front wall of the vagina
  • uterine prolapse, when the uterus sags down into the vagina
  • vault prolapse, in which the top (vault) of the vagina bulges down after a hysterectomy

The extent of a pelvic prolapse can vary. Around the same time, some people can experience various forms of prolapse, such as a prolapse of both anterior and posterior vaginal wall.

Symptoms

A tiny rectocele can not cause any symptoms.

Health professionals conducting regular physical examinations, according to the American Society of Colon and Rectal Surgeons, believe a rectocele is present in about 40 percent of women, although they may not recognize it.

In mild cases of rectocele, the patient may experience pressure inside the vagina, or after using the bathroom they may feel their intestines are not fully clean.

For mild situations, an evacuation attempt will drive the stool through the anus into the rectocele rather than out.

During evacuation, pain and discomfort may develop. Constipation is more likely, and there can be pain during sexual intercourse.

Others claim it sounds like “it is coming out” or going down inside the pelvis.

In extreme cases, fecal incontinence can occur, and the bulge will often prolapse through the vagina’s mouth (opening), or through the anus.

Causes

A rectocele typically occurs with pregnancy and childbirth, but with age the risk often increases, and other factors can play a part.

The underlying cause is a weakening of the pelvic support structures and the rectovaginal septum, the tissue layer that separates the rectum from the vagina.

Pregnancy and childbirth

Pregnancy and delivery are major factors in the development of a rectocele.
Pregnancy and delivery are major factors in the development of a rectocele.

Because of childbirth, it is more likely to occur if the baby was heavy (weighing more than 9 pounds) or labor was prolonged, or if, for example, twins had multiple births.

The more a woman has had vaginal deliveries, the greater the risk she has of developing a rectocele.

With a cesarean delivery, the risk is lower but a rectocele can still occur.

Older age

By the age of fifty, about half of all women have some signs of a pelvic organ prolapse, and by the age of eighty, more than one in every ten women would have had prolapse surgery.

If the rectocele is low the person can not notice it. If tall, they can find tissue protruding through the opening of the vagina. There can be some discomfort, some pressure, and occasionally, some pain.

Other factors

Those who have never given birth can also develop a rectocele.

The following are risk factors:

  • a drop in estrogen levels at menopause, making pelvic tissues less elastic
  • a hysterectomy or other pelvic surgery
  • chronic constipation
  • long-term coughing, such as in chronic bronchitis
  • sexual abuse during childhood
  • being obese or overweight
  • regularly lifting heavy objects

Hemorrhoids can have an indirect connection. For example, if a person with other risk factors also has chronic constipation, a forced bowel movement while straining can increase the intra-abdominal pressure. That can cause a rectocele.

When a person undergoes multiple gynecological or rectal operations, the pelvic floor may also be compromised and a rectocele may develop.

As a treatment for prostate cancer, a rectocele may develop in men as a result of a prostatectomy, which is the removal of the prostate gland.

Females are more likely to have a rectocele than men.

Diagnosis

After examining the vagina and rectum, a doctor would usually make a diagnosis The size of the rectocele can then be calculated by an imaging test.

The account of the individual how the rectocele affects their life may aid in assessing the degree of prolapse.

When during a physical exam, a doctor notices something odd, they can prescribe an imaging test, such as MRI or X-ray, to search for potential causes of the problem.

A defecogram is a particular form of X-ray test that lets the physician assess the extent of the rectocele and how well the patient evacues.

Treatment

A doctor can recommend home remedies, medication or, in some cases, surgery, depending on how serious the rectocele is.

Home remedies

A woman drinking water
Drinking water can help to ease constipation.

The following tips can help avoid the development of a rectocele, and — if there is already a rectocele — can stop the symptoms from getting worse.

  • Pelvic floor exercises, such as Kegel exercises, can strengthen the pelvic floor muscles.
  • Drinking plenty of fluids and eating high-fiber foods can reduce constipation.
  • Avoiding any type of heavy lifting can also prevent a worsening of symptoms.
  • Getting treatment for prolonged coughing can reduce strain on the pelvic floor muscles.
  • Losing weight may be advisable if a person has obesity or excess weight.

Long straining while defecating can exacerbate the problem. It will help avoid constipation.

Medications

The doctor may prescribe:

  • stool softeners to ease constipation
  • hormone replacement therapy (HRT) for use after menopause.
  • a vaginal pessary — a plastic or rubber round disk inserted into the vagina — to support the protruding tissues

Surgery

Interventions for different kinds of pelvic organ prolapse include:

  • sacral colpopexy
  • sacrospinous colpopexy
  • uterosacral colpopexy
  • transvaginal mesh

The surgeon may remove the tissue which is stretched or damaged. They will also use a mesh inlay to reinforce the wall between the vagina and the rectum.

The procedure can range from open surgery to minimally invasive operation. In some cases, the damaged tissue will be repaired by a surgeon, usually by incising the vagina.

The gynecologist will discuss options with the patient, and the choice will possibly depend on the severity of the prolapse and the condition of the person, including age, general health, and whether or not they want more children.

Prevention

A variety of behaviors can reduce or worsen the chances of developing a rectocele.

After childbirth: The prescribed Kegel exercises should be performed daily for someone who has recently given birth.

Chronic cough: Medical care should be obtained by those with chronic cough, respiratory infections and other lung problems. Smoking cigarettes is more likely to and should be stopped in the lung conditions.

Healthy body weight: The risk can be reduced by maintaining healthy body weight. A balanced diet and a lot of water can help avoid constipation. When attempting to clear the bowels, individuals should prevent excessive straining in constipation.

Anyone who has a prolapse already should stop such things as heavy lifting, because they can make it worse.

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