In gynecology, a rectocele ( ) or posterior vaginal wall prolapse results when the rectum bulges (herniates) into the vagina. Two common causes of this defect are childbirth and hysterectomy. Rectocele also tends to occur with other forms of pelvic organ prolapse, such as enterocele, sigmoidocele and cystocele.

Causes

Rectoceles result from the weakening of the pelvic floor also called pelvic organ prolapse. Weakened pelvic structures occur as a result of an episiotomy during previous births, even decades later. Other causes of pelvic floor prolapse can be advanced age, multiple vaginal deliveries, and birthing trauma. Birthing trauma includes vacuum delivery, forceps delivery, and perineal tear.  In addition, a history of chronic constipation and excessive straining with bowel movements are thought to play a role in rectocele.  Multiple gynecological or rectal surgeries can also lead to weakening of the pelvic floor. as can chronic constipation and straining to pass bowel movements. It is more common in older women than in younger ones because estrogen which helps to keep the pelvic tissues elastic decreases after menopause.

Diagnosis

The diagnosis of a rectocele primarily occurs with a physical examination and an interview where symptoms of difficulty defecating are reported.  Women often mention the need to insert a finger in the vagina or use of suppositories and/or enemas to aid in having a bowel movement. They may report that strenuous pushing to defecate causes bleeding and pain.  Surveys about the impact on quality of life may be administered to aid in determining the need for treatment.

A pelvic exam and digital rectal exam are done to evaluate the amount of protrusion and anal sphincter tone.

Treatment

Non-surgical

Treatment depends on the severity of the problem, and may include non-surgical methods such as changes in diet (increase in fiber and water intake), pelvic floor exercises such as Kegel exercises, use of stool softeners, hormone replacement therapy for post-menopausal women and insertion of a pessary into the vagina. Vaginal pessaries can immediately relieve prolapse and prolapse-related symptoms. A high fiber diet, consisting of 25–30 grams of fiber daily, as well as increased water intake (typically 6–8 glasses daily), help to avoid constipation and straining with bowel movements, and can relieve symptoms of rectocele.

Surgical

Surgery can be done to correct rectocele when symptoms continue despite the use of non-surgical management, and are significant enough to interfere with activities of daily living.

References

  • Rectocele details, description, video (in Russia)