Rectocele

Rectoceles are usually caused by thinning of the rectovaginal septum (the tissue between the rectum and vagina) and weakening of the pelvic floor muscles. There are many things that can lead to weakening of the pelvic floor, including:

• Vaginal deliveries
• Trauma from vaginal delivery (e.g. the use of forceps or vacuum during delivery, tearing or episiotomy, which is a surgical cut in the muscular area between the vagina and the anus made just before delivery)
• History of constipation
• Chronic straining with bowel movements
• Gynecological (e.g. hysterectomy) or rectal surgeries

Most people with a small rectocele do not have symptoms. When the rectocele is large, there is usually a noticeable bulge into the vagina.

Symptoms

Rectal Symptoms

• Difficulty having a complete bowel movement
• Stool getting stuck in the bulge of the rectum
• The need to press against the vagina and/or space between the rectum and the vagina to have a bowel movement
• Straining with bowel movements
• The urge to have multiple bowel movements throughout the day
• Constipation
• Rectal pain

Vaginal Symptoms

• Pain with sexual intercourse (dyspareunia)
• Vaginal bleeding
• A sense of fullness in the vagina

Preventive and Medical Tips

• Eating a high-fibre diet and taking over-the-counter fiber supplements (25-35 grams of fibre/day)
• Drinking more water (typically 6-8 glasses daily)
• Avoiding excessive straining with bowel movements
• Applying pressure to the back of the vagina during bowel movements
• Pelvic floor exercises under the guidance of a physiotherapist
• Stool softeners
• Hormone replacement therapy

Treatment

Non-Surgical

The goal is to have good daily bowel habits and softer stools. Avoiding constipation and straining with bowel movements will reduce the risk of a bulge associated with a rectocele.

Surgical

The surgical management of rectoceles should only be considered when nonsurgical methods have not resolved or improved symptoms and the condition interferes with daily living. This can be done through laparoscopic, robotic or vaginal surgery. The choice of procedure depends on the size of the rectocele and its symptoms. The goal of surgery is:

• To remove the extra tissue caused by the rectocele
• To strengthen the wall between the rectum and vagina, usually now performed by using your own tissues to do this (native tissue repair)
• Rarely, mesh may be used in this repair. This has been controversial in recent years and I recommend speaking with your gynaecological surgeon more about this