Rectocele Prolapse

Rectocele is a herniation of the tissue wall between the vagina and the rectum. Over time, this tissue wall - also known as the rectovaginal septum - can become weakened resulting in a pelvic organ hernia or pelvic organ prolapse. In this article we will discuss what a rectocele is, what the symptoms are, and how it can be treated.

What is a Prolapsed Rectocele?

A rectocele is a herniation, prolapse, or weakening of the rectovagianl septum (tissue wall between the rectum and the vagina). Rectocele is also commonly known as a posterior vaginal prolapse or a proctocele. This can occur as an isolated injury or gradual weakening of the tissues, or occur as a result of prolonged pelvic floor dysfunction. When the pelvic floor is weakened along with the ligaments and tissues between the vagina and the rectum, it can cause the vaginal and rectal walls to weaken and bulge leading very painful symptoms and other pelvic organ related issues. In severe cases, the vaginal or rectal walls can bulge and protrude from the vaginal opening.

Other types of Pelvic Floor Prolapse

There are several other types of pelvic organ prolapse that may present themselves in similar ways as rectocele:

• Cystocele, or anterior vaginal prolapse: occurs when a woman's bladder bulges into the vaginal wall
• Uterine prolapse: occurs when the uterine walls become weakened or unsupported and the uterus bulges into the vaginal wall.
• Rectal prolapse: occurs when the rectal wall is weakened and protrudes through the anus
• Vault prolapse: occurs when the  vaginal vault (top of the vagina) bulges.

Pelvic prolapses can vary greatly in their severity and at times, different types may occur simultaneously.

What is the Main Cause for a Rectocele?

Although the exact cause of a rectocele is unknown, it is most commonly a result of a weakened pelvic floor and often goes hand in hand with excess pelvic pressure and intra abdominal pressure. A woman's pelvic floor can become weak after undergoing physically traumatic experiences such as: childbirth through vaginal delivery, difficulties with vaginal childbirth (if forceps or a vacuum were used, vaginal tearing, or an episiotomy). It is common for women to experience some form of pelvic floor or core weakness related issue postpartum. However, women who have never been pregnant can still develop a rectocele.

Other Causes of Rectocele

There are several other factors that may lead someone to develop a rectocele. Posterior pelvic organ prolapse can occur as a result of increased, intra-abdominal pressure. Outside of pregnancy, other causes of rectocele and increased pelvic pressure include:

• Chronic constipation
• Straining, difficulty in performing bowel movements
• Chronic cough, pneumonia, or bronchitis
• Hysterectomy
• Pelvic region surgery
• Improper heavy lifting techniques
• Obesity
• Age

What Does a Rectocele Feel Like?

In some cases, women who have a rectocele will be asymptomatic. Rectocele is actually fairly common and some studies have found that over 40% of women will discover they have a rectocele during their annual physical exam. Common symptoms of a vaginal rectocele  a woman may feel are a bulge or sensation of fullness in her vagina, feel tissue pressing out of her vaginal opening, irregular bleeding, and/or painful intercourse and often there is a sensation of a “bubble” inside her vagina. The symptoms of a rectal prolapse may include a feeling of discomfort, difficulty, or pain while attempting to have a bowel movement. In some cases, in order to have a bowel movement, the person may need to use their fingers (known as splinting) to aid evacuation by pressing against the vaginal wall or rectovaginal septum.

What are the Symptoms of a Prolapsed Bowel?

There are many possible symptoms with rectocele. As stated above, a rectocele may be diagnosed as either rectal or vaginal. In either case, the symptoms of both may include any of the following:

• Feeling of pressure of bloatedness in the pelvic region
• The feeling of something out of place in the pelvic region, or something is falling out of the vagina or rectum
• Severity of symptoms increase with movement, decreased with rest
• Lower-abdominal pain
• Lower-back pain
• A bulge within the vagina
• A bubble trapped inside the vagina
• Non-menstrual bleeding
• Pain during sex, or inability to have vaginal intercourse
• Chronic constipation
• Pain or difficulty with bowel evacuation
• Feeling a bowel movement is incomplete after finishing
• Fecal incontinence (uncommon)

How do you Diagnose a Rectocele?

Diagnosing a rectocele is completed during a pelvic exam which includes a vaginal and rectal examination. During a typical pelvic exam, your doctor may ask you to perform tasks to help determine the strength of your pelvic floor. This may include bearing down as if you were performing a bowel movement, or clenching your pelvic muscles as if you were abruptly ending a stream of pee. Further information may be needed in order for a complete diagnosis. Your doctor may ask you more questions regarding how large your prolapse may be, how it affects your day to day life, and other symptoms you may be facing. Rarely will imaging be necessary for a diagnosis. It is recommended to have any prolapse exam while standing rather than lying down.

How do you Fix a Rectocele?

Healing a rectocele can be done in a manner of ways. The most common treatment options for a rectocele rarely involve surgical measures and may not need treatment if asymptomatic. Treatment depends on the severity of your rectocele and how it may affect your life. There are many natural and medical treatment options for rectocele. Surgery is rare for rectocele treatment and is usually only considered in severe cases.

Non-Surgical Treatment for Rectocele

The majority of people with rectocele will find healing through natural remedies and non-surgical, medical measures. These may include core exercises, dietary restrictions, and medications to aid with constipation. Treatment options may include, but are not limited to:

• Pelvic exercises, such as yogic exercises, to help strengthen your pelvic floor muscles
• Staying hydrated and and eating high-fiber foods to reduce bowel issues
• Treating a chronic cough to aid in reducing pressure and strain on the pelvic floor muscles
• Avoiding heavy lifting or any core exercises that increase intra-abdominal pressure
• Losing weight may also help relieve pressure on the pelvic region
• Stool softeners to reduce strain during bowel evacuation
• Hormone replacement therapy for women post-menopause
• Or the use of a vaginal pessary to aid in protrusion issues.

To learn more about holistic healing for rectocele, consider checking out my Restore Your Core program which aids women in strengthening functional cores and pelvic floors.

Rectocele Surgery

There are many ways to approach surgical repair for rectocele. These can all be performed either transanally, transvaginally, or through the perineum (rectovaginal septum). All rectocele surgeries seek to remove any excess tissue and reinforce the weakened or damaged ligaments and muscles. The surgery will accomplish this by either stitching together the excess tissues or adding in a transvaginal mesh (although currently met with caution due to increased health risks). Some of the most common surgeries to treat vaginal prolapse include:

• sacral colpopexy - repairing apical pelvic organ prolapse (open abdominal surgery)
• sacrospinous colpopexy - vaginal vault repair surgery
• uterosacral colpopexy - transvaginal procedure for apical vaginal prolapse
• S.T.A.R.R. technique - machine that removes and staples together excess tissue, treats rectal prolapse and/or bowel obstruction
• transvaginal mesh - outdated surgery to reinforce the vaginal wall to prevent urinary incontinence and treat POP.