A rectocele is a bulge in the wall of the rectum into the vagina. The wall of the rectum becomes thin and weak and it may balloon out into the vagina when you have a bowel movement.

Causes of Rectocele

The wall that lies between the rectum (front wall of the rectum) and the vagina (back wall of the vagina) is called the rectovaginal septum. The thinning of the rectovaginal septum and weakening of the pelvic support structures is the underlying cause of a rectocele.

The most common causes of developing a rectocele are childbirth and chronic constipation. The muscles and ligaments in the pelvis that hold up and support the female organs become stretched and weakened during straining. The more babies you have, the more the support tissues are stretched and weakened. Not everyone who has a baby will develop a rectocele. Some people have stronger support tissues in the pelvis and may not have as much of a problem as others.

Other conditions that can cause a rectocele include chronic constipation, a chronic cough, a lot of heavy lifting and obesity. Older women may develop a rectocele due to the loss of female hormones causing the vaginal tissue to become weaker.

Symptoms of Rectocele

A small rectocele may not cause any symptoms. If you do have symptoms, they may include:

  • Rectal pressure or fullness
  • Protrusion of the lower part of the vagina through the opening of the vagina
  • Constipation and trapping of the stool, making it difficult to have a bowel movement (you may have to press on the lower part of your vagina to help push the stool out of your rectum, this is called splinting)
  • Sensation of incomplete emptying of stool
  • A rapid urge to have a bowel movement after leaving the bathroom due to stool returning to the lower rectum that was trapped in the rectocele
  • Incontinence after having a bowel movement

Diagnosing Rectocele

Your health care provider will ask about your symptoms and perform a pelvic exam. Your provider will ask you to bear down, pushing like you are having a bowel movement so they can see how far the lower part of the vagina protrudes into the vagina and possibly outside of the vagina. They will ask you to contract the muscles of your pelvis (like you are stopping the stream in the middle of urinating) to determine the strength of your pelvic muscles. Your provider also may do a rectal exam and may ask you to have a defecography, which is a special x-ray that looks at the pelvic organs while you are straining like when you are having a bowel movement.

Rectocele Treatment

If the rectocele is not causing any symptoms, treatment may not be needed. If you are experiencing symptoms, a combination of non-surgical and surgical treatments is needed to correct the problem. These treatment options may include:

  • Avoid constipation by eating a diet rich in fiber and drinking 6–8 glasses of decaffeinated fluid every day can assist in keeping bowel movements soft. Your provider may recommend stool softeners as well.
  • Avoid prolonged straining. If the bowels will not completely empty after a bowel movement, get up and return later. Pelvic floor physical therapy can help with retraining your muscles to avoid straining and have a bowel movement correctly.
  • Use a pessary (a ring that is inserted in the vagina) to assist in supporting pelvic organs
  • Avoid heavy lifting and learn to lifting correctly – with your legs not with your waist or back
  • Treat a chronic cough or bronchitis
  • Not smoke
  • Avoid too much weight gain
  • Do Kegel exercises, especially after you have a baby.
  • Use splinting, which is inserting a tampon or two fingers inside the vagina and pushing back
  • Surgery may be necessary if the rectocele is severe. A rectocele repair may be performed through the anus, vagina, perineum (between the anus and vagina), the abdomen or there may be a combined repair.

Additional Resources

Make an Appointment

To schedule an appointment or learn more, call the Michigan Bowel Control Program at 734-763-6295.