Definition Rectocele is a condition in which part of the rectum protrudes or bulges into the back wall of the vagina.
What is going on in the body? The rectum lies just behind the vagina in a female. Between the rectum and vagina is a wall made of tissues and muscles that support the rectum and vagina. When a woman has a rectocele, the wall supporting the rectum is weaker than usual. This weakening allows part of the rectum to protrude into the vagina. As the rectum becomes stretched, it bulges into the vagina. The woman may experience difficulty passing stool.
What are the signs and symptoms of the disease? Symptoms of a rectocele may include:
What are the causes and risks of the disease? Rectocele results from a weakening or stretching of the tissues supporting the rectum. The causes of this weakening include:
muscles and tissues being stretched during childbirth
heavy lifting that causes stress on the muscles surrounding the vagina and rectum
chronic constipation or repeated straining during bowel movements
menopause. Oestrogen helps keep the muscles around the vagina strong. During menopause, oestrogen levels decrease.
normal ageing, which can cause the muscles become weaker
What can be done to prevent the disease? This condition may not be preventable. Using caution when doing heavy lifting may decrease the risk. Careful monitoring, and an episiotomy if necessary, may prevent rectocele during childbirth.
Kegel exercises may strengthen the wall supporting the vagina and rectum. A pessary may help keep a rectocele from becoming worse. This is a device that can be put into the vagina to hold the rectum in place.
Staying active and eating a healthy diet with fibre, fruits, and vegetables may decrease constipation.
How is the disease diagnosed? Diagnosis of a rectocele begins with a complete history and physical, including a pelvic exam and rectal exam. Other tests may include:
ultrasound, which uses sound waves to show the uterus, bladder, rectum, and cervix
defecography, in which X-rays of the rectum are taken while the person has a bowel movement
stool culture, in which the stool is examined for bacteria
blood tests, including a full blood count, or FBC, to check for infection
other X-rays, scans, or tests to rule out other causes of the symptoms
What are the long-term effects of the disease? Long-term effects depend on the severity of the condition. Rectocele may lead to constipation, haemorrhoids, a hole in part of the intestine, or hard stool that blocks the intestine. Embarrassment about leaking stool can cause stress. Other long-term effects will depend on the success of treatment.
What are the risks to others? Rectocele is not contagious and poses no risk to others.
What are the treatments for the disease? Treatment of rectocele is aimed at treating and reducing symptoms. These measures may help:
avoiding straining during bowel movements or heavy lifting
eating a healthy diet, especially one with more fibre
staying active
using stool softeners to keep stools soft
doing Kegel exercises to strengthen the muscles supporting the rectum and vagina
using a pessary, which is a device fitted into the vagina to hold the rectum in place
the use of surgery for severe or persistent symptoms, or for a progressive rectocele. The goal of the surgery is to move the rectum back into its normal position and hold it there. The muscles of the vagina and rectum can also be strengthened with surgery.
What are the side effects of the treatments? Medications used to treat constipation may cause side effects, including nausea, headache, or diarrhoea. Surgery carries a risk of bleeding, infection, and allergic reactions to anaesthesia.
What happens after treatment for the disease? Treatments such as activity and diet modifications might be life long. Recovery from surgery may take a few days to several weeks, depending on the procedure used.
How is the disease monitored? Any new or worsening symptoms should be reported to the doctor.
Author: Eileen McLaughlin, RN, BSN Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
