A rectocele is a bulge of the front wall of the rectum into the vagina. The rectal wall may become
thinned and weak, and it may balloon out into the vagina when you push down to have a bowel movement.
Most rectoceles occur in women where the front wall of the rectum is up against the back wall of
the vagina. This area is called the rectovaginal septum and may be a weak area in the female
anatomy. Other structures may also push into the vagina. The bladder bulging into the vagina is
called a cystocele. The rectum bulging into the vagina is termed a rectocele. And the small
intestines pushing down on the vagina from above may form an enterocele. Although uncommon, men
may also develop a rectocele.
A rectocele may be present without any other abnormalities. In some cases, a rectocele may be part
of a more generalized weakness of pelvic support and may exist along with a cystocele, urethrocele,
and enterocele, or with uterine or vaginal prolapse, rectal prolapse, and fecal or urinary
The underlying cause of a rectocele is a weakening of the pelvic support structures and thinning
of the rectovaginal septum. Certain factors may increase the risk of a woman developing a
rectocele. These include birth trauma such as multiple, difficult or prolonged deliveries, the
use of forceps or other assisted methods of delivery, perineal tears, or an episiotomy into the
rectum or anal sphincter muscles. In addition, a history of constipation and straining with
bowel movements, or hysterectomy may contribute to the development of a rectocele. Commonly,
these problems develop with age but they may occasionally occur in younger women or in those
that have not delivered children.
Many women have rectoceles but only a small percentage of women have symptoms related to the
rectocele. Symptoms may be primarily vaginal or rectal. Vaginal symptoms include vaginal bulging,
the sensation of a mass in the vagina, pain with intercourse or even something hanging out of
the vagina that may become irritated.Vaginal bleeding is occasionally seen if the vaginal lining
of the rectocele is irritated, but other sources of the bleeding should be checked by your
doctor. Rectal symptoms include constipation, particularly difficult evacuation with straining.
Often this is associated with bulging in the vagina when straining to have a bowel movement. Some
women find that pressing against the lower back wall of the vagina or along the rim of the
vagina helps to empty the rectum. At times, there will be a rapid return of the urge to have
a bowel movement after leaving the bathroom because stool that was trapped in the rectocele
may return to the low rectum after standing up. A general feeling of pelvic pressure or
discomfort is often present but this may be due to a variety of problems.
Most rectoceles may be identified on a routine office examination of the vagina and rectum.
However, it may be difficult to assess the size and significance of the rectocele. A more
accurate method of assessing the rectocele is an x-ray study called a defecagram. This study
shows how large the rectocele is and if it empties with evacuation.
You should consider having your rectocele treated when it causes significant symptoms. It
takes an experienced doctor to help you decide whether your symptoms are caused by a rectocele.
If there are multiple abnormalities present, it may be best to address them all at once as this
will result in the best chance for improvement.
Rectoceles that are not causing symptoms do not need to be treated. In general, you should
avoid constipation by eating a high fiber diet and drinking plenty of fluids.
A bowel management program is the best first step. This includes a diet high in fiber and 6 to
8 glasses of fluids each day. Fiber acts like a sponge. It soaks up fluid so that less is
removed as the stool travels around the colon. The stools will be larger, softer and easier
to pass. You may wish to add a fiber supplement and/or a stool softener to this regimen to
improve stool consistency. Most fiber supplements are made of psyllium, a seed product, or
of a hydrophilic colloid (gel) that absorbs water. Most stool softeners are composed of
docusate. This helps to smooth and lubricate the stool. Active laxatives are best avoided in
Avoid prolonged straining. If you cannot completely empty, get up and return later. Holding
pressure with a finger to support the rectocele and encourage the stool to go in the correct
direction is often helpful. This may be accomplished by pressing against the lower back wall
of the vagina or along the posterior rim of the vagina. Avoid placing a finger inside the anus
to pull the stool out as this may cause harm. A pessary may be used to support the pelvic
organs. It is a ring that is inserted into the vagina and must be individually fit to each
If symptoms persist even with medical therapy, then surgical repair may be indicated. There
are several surgical techniques used to repair a rectocele. A rectocele repair may be performed
through the anus, through the vagina, through the perineum between the anus and vagina, or
from above through the abdomen. When there is extensive pelvic relaxation and prolapse, the
best approach may be a combined repair.