Service
Rectocele: symptoms and treatment
- Section
- Services
- Specialist
- Op. Dr. Dilara Hasanova
- Clinic
- Modern Hospital, Baku
- The doctor's practice — examinations and treatments Dr. Hasanova performs herself
- General information — educational text about diseases and methods
What is a rectocele?
Short answer
A rectocele is a bulging of the front wall of the rectum toward the back wall of the vagina. In everyday speech it is also called “perineal sagging” or “bowel hernia.” It develops when the muscle and connective tissue between the rectum and the vagina weaken or are injured during childbirth. The main symptoms are difficulty with bowel movements, a feeling of incomplete emptying and a feeling of fullness in the vagina. A rectocele should not be confused with hemorrhoids.
Causes and risk factors
- Multiple vaginal births, a large baby
- Difficult childbirth: vacuum, forceps, episiotomy, perineal tears
- Chronic constipation and long-term straining
- Chronic cough, frequent heavy lifting
- Excess weight
- Weakening of the tissues with age and menopause
- Previous pelvic operations (for example, hysterectomy)
Symptoms
A small rectocele may cause no complaints. As it grows larger, these symptoms appear:
- A feeling of incomplete emptying after a bowel movement
- A need to strain hard, chronic constipation
- A feeling of stool “getting stuck” toward the vagina
- A need to press with a finger on the perineum or on the back wall of the vagina in order to have a bowel movement
- A soft bulge, a feeling of fullness and heaviness in the vagina
- Discomfort or pain during sexual intercourse
- Pain in the perineum, low back pain
- Sometimes difficulty holding gas or stool
Other prolapses of the pelvic organs may also occur together with a rectocele: prolapse of the bladder (cystocele), the uterus or the small intestine (enterocele). These cases are assessed together with a gynecologist.
Diagnosis
- Proctological and vaginal examination, assessment during straining
- Digital rectal examination
- Defecography — an X-ray or MRI study that shows the movement of the rectum and pelvic floor during a bowel movement
- Anal manometry and other functional tests when needed
Treatment
General information
Conservative treatment is the first step for small rectoceles that cause few symptoms:
- A fiber-rich diet, enough fluids, resolving constipation
- Not straining, placing a small stool under the feet during a bowel movement
- Pelvic floor exercises (Kegel), pelvic floor rehabilitation under a physiotherapist's supervision, the biofeedback method
Surgical treatment is intended for a rectocele that causes symptoms and does not respond to conservative treatment. One of the widely used methods is posterior colporrhaphy, performed through the vagina and combined with levatorplasty when indicated: the weakened tissue between the rectum and the vagina is repaired and the pelvic floor muscles are strengthened. In selected cases, other approaches are also used. Read more: Posterior colporrhaphy and levatorplasty
The doctor's practice
Examinations and treatments Dr. Hasanova performs herself
- In treating rectocele, she regularly performs posterior colporrhaphy and levatorplasty operations.
- If hemorrhoids, an anal polyp or an anal fissure are present together with a rectocele, she also treats them in the same session when needed (for example, LigaSure hemorrhoidectomy).
- She has performed repeat (reconstructive) operations for rectoceles that recurred after an operation done at another clinic.
- When gynecological problems such as uterine prolapse are also present, the operation can be planned jointly with a gynecologist-surgeon.
- She performs the operations mainly under spinal anesthesia.
After the operation
- Recovery usually takes several weeks, and the rehabilitation period lasts about 1 month.
- In the first weeks, it is recommended not to lift heavy objects, not to strain, and to soften the stool.
- The doctor determines when to return to sexual activity at the follow-up visit.
- Possible complications: pain, bleeding, infection, pain during sexual intercourse, recurrence.
Frequently asked questions
Is a rectocele the same as hemorrhoids?
No. Hemorrhoids are an enlargement of the vascular cushions of the anal canal, while a rectocele is a bulging of the rectum toward the vagina. Both can cause difficulty with bowel movements and discomfort, and they sometimes occur together. An accurate diagnosis is made by proctological examination.
Will a rectocele go away on its own?
A rectocele does not disappear on its own, but in small rectoceles, resolving constipation, proper bowel habits and pelvic floor exercises can reduce symptoms and slow progression. If the symptoms impair quality of life and conservative treatment does not help, surgical treatment is discussed.
Do Kegel exercises help with a rectocele?
Kegel exercises strengthen the pelvic floor muscles and can reduce symptoms in mild cases. They do not, however, eliminate a large rectocele that has already formed. A doctor or a pelvic floor physiotherapist can teach the correct technique.
If I plan to give birth in the future, when can the operation be done?
The timing of the operation depends on how severe the symptoms are and on pregnancy plans. If the symptoms seriously disrupt daily life, the operation can be planned sooner. If a birth is planned in the near future, this is taken into account in the decision about surgery. The decision is made together with the doctor.