When tissue that keeps the vagina and rectum separate begins to weaken, the result is a rectocele.
Rectocele is also referred to as posterior vaginal wall prolapse. It’s a type of herniation (bulge) that often develops gradually over time. With rectoceles that are small, women may have no symptoms. If the protrusion is more extensive, a referral may be made to a urologist to determine whether or not other pelvic structures – like the bladder and small intestine – are involved.
Treatment options will depend on the severity of this type of vaginal prolapse.
Small rectoceles often produce little or no symptoms. In fact, it’s estimated that nearly half of all women with a prolapse of this nature are diagnosed during a routine gynecological, urologic, or physical examination. If symptoms or signs are experienced or present, they may include:
Tissue protruding through the vaginal opening
Trouble with regular bowel movements
Rectal pressure or a feeling of “fullness" in this area
Discomfort during sexual intercourse and/or vaginal bleeding
Diagnosing Posterior Vaginal Prolapse
If it’s suspected that a woman has a rectocele, a pelvic exam is typically performed. This may involve asking a patient to strain as if making a bowel movement and attempt to stop the urination process. The purpose of these two actions is to determine the size and location of the prolapse and get an idea of how pelvic muscles are affected. In some instances, an image test may be done to rule out other possible pelvic issues. Some patients are also asked to go through a test that shows how well the rectum is emptying (defecography).
Non-Surgical Treatment Options
With a minor or non-symptomatic rectocele, treatment may involve periodic examinations and self-care recommendations, such as Kegel exercises to strengthen pelvic muscles and dietary changes to minimize bowel/rectal straining. Some women are able to control symptoms with the use of a rubber or plastic vaginal insert (vaginal pessary) that’s meant to be periodically removed to maintain optimal vaginal hygiene. Non-surgical treatment/symptom management may also include:
Increasing water intake
Biofeedback targeting the pelvic floor area
Using stool softeners and eating more fiber-rich foods
Correction with Surgery
If posterior vaginal wall prolapse is severe or other pelvic/urologic structures are affected, surgery may be performed to remove excess tissue and insert mesh material to strengthen the wall between the rectum and vagina (rectovaginal septum). Surgery might be performed through the vagina or the anus. The way surgery is performed will depend on the size and location of a rectocele. Another option is to remove and staple tissue in the affected area with a special device. This is called the S.T.A.R.R. technique. Also, open or laparoscopic surgery may be done via the abdomen to correct this problem.
It’s not always possible to prevent a rectocele since some women are born with connective tissues in the pelvic area that are weak, which increase the risk of posterior vaginal wall prolapse occurring. Additional risk factors include vaginal childbirth, carrying around excess weight, and the natural loss of muscle mass that occurs with age. Some women may be able to reduce the chances of having a rectocele by being proactive about reducing constipation, staying within a healthy weight range, and being cautious when lifting anything heavy.