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Refers to a posterior vaginal wall prolapse that results when the rectum herniates into or forms a bulge in the vagina.
The two common causes are: childbirth, and hysterectomy.
Tends to occur with other forms of pelvic organ prolapse such as enterocele, sigmoidocele and cystocele.
More common in older women than in younger ones, as strogen which helps to keep the pelvic tissues elastic decreases after menopause.
Very uncommonly can occur in men associated with prostatectomy.
Patients with mild rectocele experience a sense of pressure or protrusion within the vagina, and occasionally feeling that the rectum has not been completely emptied after a bowel movement.
Patients with moderate cases may involve difficulty passing stool, discomfort or pain during evacuation or intercourse, constipation, and a general sensation that something is falling out within the pelvis.
Vaginal bleeding, intermittent fecal incontinence, or even the prolapse of the bulge through the mouth of the vagina, or rectal prolapse through the anus can occur in severe cases.
By manual pushing, on the posterior wall of the vagina helps to aid in bowel movement in a majority of cases of rectocele.
Can be a cause of symptoms of obstructed defecation.
Weakening of the pelvic floor, also called pelvic prolapse causes rectoceles.
Episiotomy can lead to weakened pelvic structures, even decades later.
Pelvic floor prolapse and rectoceles are associated with advanced age, multiple vaginal deliveries, birthing trauma due to vacuum delivery, forceps delivery, and perineal tear, chronic constipation and excessive straining with bowel movements.
Multiple gynecological or rectal surgeries can also lead to weakening of the pelvic floor as well.
Rectocele may involve births of babies over nine pounds in weight, or rapid birth delivery
A hysterectomy or other pelvic surgery can be a cause.
Treatment depends on the severity of the problem.
Treatments include: non-surgical methods such as changes in diet to avoid constipation, 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.
A high fiber diet helps to avoid constipation and straining with bowel movements, and can relieve symptoms.
If significant symptoms persist after non-surgical approaches, surgery can considered.
Surgical management of a rectocele may involve the reattachment of the muscles that previously supported the pelvic floor, or a posterior colporrhaphy, which involves suturing of vaginal tissue, and may also involve insertion of a supporting mesh, or repairing or strengthening the rectovaginal septum.
Complications of surgical repair of a rectocele include: bleeding, infection, dyspareunia , recurrence or even worsening of the rectocele symptoms.