Rectocele

What Is It?

In women, the vagina is separated from the rectum by a firm wall of tough, fibrous tissue called fascia. Sometimes, an area of this wall gets weak, and part of the rectum bulges into the vagina. This bulge is called a rectocele.

The problem usually develops after the wallis damaged during a vaginal delivery. The bulge may occur after a vaginal delivery, but symptoms may not develop until much later in life. Rectoceles are more commonly seen in older women who have entered menopause.

Some conditions can increase the risk of developing rectocele, including chronic constipation, chronic cough, repetitive heavy lifting, or any activity which puts pressure on the pelvic floor over time.

Because small rectoceles often do not cause any symptoms, it is difficult for health experts to determine exactly how often they occur. As few as 20%, or as many as 80% of adult women may be affected, but rectoceles are most commonly seen in older women who have had multiple vaginal deliveries. In one recent study of 125 women in the United States who had rectoceles, the typical patient was about 60 years old, going through menopause, and had gone through two or three vaginal deliveries. A woman with a rectocele is also likely to have related conditions, including a cystocele (an abnormal bulging of the bladder through a weakness in the anterior vaginal wall) and uterine prolapse (abnormal sagging of the uterus into the vagina because of loss of its pelvic support).

Symptoms

A small rectocele may not cause any symptoms, especially if it bulges less than 2 centimeters (less than 1 inch) into the vagina. However, larger rectoceles can trigger a variety of rectal and vaginal complaints, including:

• A bulge of tissue protruding through the vaginal opening

• Constipation

• Difficulty having a bowel movement

• Pain or discomfort during sexual intercourse

• A feeling that the rectum has not emptied completely after a bowel movement

• A sensation of rectal pressure

• Rectal pain

• Difficulty controlling the passage of stool or gas from the rectum

• Low back pain that is relieved by lying down - In many women, this back pain may worsen as the day goes on, and is more severe in the evening.

In about 20% of cases, the patient must use a technique called manual evacuation or digitation to help empty the rectum. In this technique, the patient presses on the rectocele with her fingers while defecating to help the stool to pass.