- In female, vagina and rectum are separated by a firm wall of tough, fibrous tissue called fascia. Rectocele or posterior vaginal prolapse is condition in which the area of this wall gets weak and part of rectum bulges into vagina.
- According to the American Society of Colon and Rectal Surgeons, health professionals carrying out routine physical examinations find a rectocele is present in around 40 percent of women, although they may not notice it.
Signs and symptoms of Rectocele
- A small rectocele (bulge is less than 2 cm or 1 inch into vagina) may not cause any symptoms.
- Large rectoceles can trigger variety of rectal and vaginal symptoms like:
- A soft bulge of tissue that may or may not protrude through vaginal opening.
- Difficulty in passing stool.
- Constipation.
- Pain and difficulty during intercourse or evacuation.
- General feeling of rectal pressure or that something is falling out or falling down within the pelvis.
- A feeling that rectum has not completely emptied after a bowel movement.
- Rectal pain.
- Difficulty in controlling passage of stool or gas from rectum.
- Lower back pain.
- In severe cases, vaginal bleeding and intermittent vaginal incontinence may occur.
Cause and risk factors of Rectocele
- Vaginal childbirth, especially multiple birth and aging are primary risk factor for rectocele.
- Lower estrogen level due to older age or menopause.
- Hysterectomy or other pelvic surgery.
- Chronic constipation or chronic cough.
- Overweight or obesity.
- Continuous lifting of heavy objects.
Diagnosis
- Doctor will check patient’s history of vaginal deliveries and vaginal tears during delivery.
- Gynecological and rectal physical examination like pelvic exam and digital rectal exam is performed.
- Defecography- a x-ray done to look at what happens during the bowel movement is performed.
- MRI, ultra-sound or moving x-ray may be helpful.
- Anorectal manometry is done to measure pressure in anus on rectum.
Prevention
Rectocele worsening can be prevented by following methods:
- Preventing and treating constipation.
- Controlling coughing.
- Avoiding weight gain.
- Avoiding heavy lifting and lift correctly.
- Performing exercise to strengthen pelvic floor muscle especially after childbirth.
Treatment
- Treatment depends on severity of problems and may include surgical or non-surgical procedures.
- Non-surgical methods include;
- Changes in diet (increase in fiber and water intake).
- Exercise to strengthen pelvic floor like kegel exercise.
- Use of stool softener.
- Hormone replacement therapy in post-menopausal women.
- A vaginal pessary (plastic or rubber round disk) inserted into vagina to support protruding tissues.
- If signs and symptoms continue even after trying non-surgical methods, surgery might be considered. The surgical methods that may be used are sacral colpopexy, uterosacral colpopexy and transvaginal mesh. The surgeon can remove the stretched or damaged tissue or use mesh patch to support wall between rectum and vagina.