What is a Rectocele?
A rectocele or posterior vaginal prolapse is the bulging of the vagina due to weakening of the rectovaginal septum and pelvic floor muscles. The rectovaginal septum is made up of fibrous tissues separating the rectum and vagina. The pelvic floor muscles are the layer of muscles supporting the pelvic organs (bladder, bowel, and uterus).
Possible risk factors that may cause a rectocele include:
- Chronic constipation
- Chronic cough associated with smoking or asthma
- Lifting very heavy objects
- Genetic factors
Small rectoceles are usually asymptomatic. Large rectoceles are associated with symptoms including:
- Bulging of the front wall of the rectum into the back wall of the vagina - usually does not protrude through the vaginal opening
- Improper bowel movements and improper emptying of the rectum
- Feeling of pressure or fullness in the rectum
- Prolapse (poking through) of the uterus or bladder
- Sexual concerns or pain during intercourse
- Rectal pain or lower back pain
Your doctor may order one or both of the following tests:
- Bladder function test: This tests the ability of your bladder to store and eliminate urine. The volume and force of the urine stream are also measured.
- Pelvic floor strength test: The strength of the pelvic floor muscles are tested.
Initially, your doctor will suggest non-surgical methods to treat rectocele. Surgery is recommended only if non-surgical methods fail.
Your doctor may suggest the use of a vaginal pessary, which is a plug-like device to overcome the bulging tissue. Kegel exercises are also recommended to strengthen the muscles.
Your surgeon may perform any one of the following methods:
Stitches may be used to reinforce the tissues which are bulging.
A mesh may be used to support and strengthen the wall between the rectum and the vagina.
Significant prolapse may require a hysterectomy (removal of the uterus). It is necessary to prepare well before surgery. If you are getting a hysterectomy, you must be sure you are not planning a pregnancy anytime in the future. Most often, laparoscopic surgery is performed through tiny incisions. You will need to stay in the hospital for a few days. Your doctor will prescribe pain medications to keep you comfortable and antibiotics to prevent infection after surgery.
Kegel exercises have been known to prevent rectocele by strengthening the pelvic muscles.
The occurrence of rectocele can be effectively prevented by following certain healthy lifestyle habits. They include:
- Managing constipation
- Losing weight, if obese
- Drinking plenty of fluids
- Eating high-fiber foods
- Avoiding lifting heavy objects
- Quitting smoking
- Managing a chronic cough
Rectocele in Men
Rectocele sometimes occurs in men, though it is rare. It may occur due to the removal of the prostate gland (prostatectomy) as a measure to treat prostate cancer.