Rectocele – Causes, Symptoms and Treatment Options

A rectocele is a type of pelvic organ prolapse where the rectum bulges and pushes the back side (posterior) of vagina. Rectocele is also called ‘Posterior Vaginal Wall Prolapse’ or ‘Proctocele’.  In our previous article, you would have read about ‘Anterior Vaginal Wall Prolapse’ in which the urinary bladder bulges into the front wall (anterior) of the vagina.

Any organ in the pelvis region can prolapse due to the loss of strength of muscles and tissues in the pelvis region due to various reasons.

Symptoms of rectocele

In cases of minor rectocele, there may be no symptoms experienced by the person.  In moderate toe severe cases, following symptoms may show up:

1. Pressure in the vagina or a bulged feeling in the vagina.
2. Person may not be able to empty bowels properly. The more they push, the stool enters the prolapsed region of rectum instead of getting out of the anus.
3. Constipation and Pain during bowel movement
4. Pain during sexual intercourse
5. Faecal Incontinence
6. In severe cases, the bulged portion may fall out of the vagina or through the anus.

What causes rectocele?

There are several factors that cause rectocele including:

1. Pregnancy and Child birth are the major causes of any prolapse and also rectocele. When a woman is pregnant, a lot of pressure is put on the pelvic muscles and also during child birth, extreme pressure is put on the muscles and tissues in the pelvis region and those around the vagina. As a result they tear.
2. If the woman has multiple vaginal child births, the damage caused to the pelvic floor muscles increases.
3. If the baby to be delivered is large or if the labour takes a lot longer than usual, the tearing of muscles is more.
4. Chronic cough can also put pressure on the muscles in the pelvis region
5. Constipation and the pressure put on the pelvis region to empty your bowels can also cause rectocele.
6. Improper way of lifting weight by putting pressure/weight on the abdominal or lower back instead of legs can result in prolapse.
7. Being overweight or obese also puts more pressure in the pelvis region.
8. In women reaching or who have attained menopause, the muscles in the pelvis region lose elasticity and strength due to lower production of estrogen.
9. Old age is also a factor due to which the pelvic muscles become weak along with all other muscles in the body.
10. Surgery to the pelvis region (one or multiple) can hurt the pelvis muscles and if the muscles don’t regain their strength that can result in prolapse.

Rectocele is commonly found in women but is found in men too. Surgery done to remove prostate (to stop prostate cancer or any other reason), can also lead to rectocele.

Diagnosis of rectocele

A good gynecologist can identify rectocele during general physical examination of any organ in your pelvis region.  The doctor may question the person about their lifestyle and other activities that might be a reason for the rectal prolapse.

In order to know the extent of rectocele, an X-Ray or an MRI may also be requested by the doctor.  The severity of the rectocele gives an idea of treatment procedure to the gynecologist/urologist. A defecogram is a type of X-ray that gives the size of the rectocele and how well the person is able to pass stools.

Treatment of rectocele

Treatment of rectocele depends on the cause. Your gynecologist or surgeon may suggest lifestyle changes, workouts or may put you onto medication or may recommend surgery depending on the stage of rectocele.

Home remedies for rectocele:

1. Kegel Exercise – to strengthen pelvic floor muscles
2. If the person has to lift weights regularly at work, doctor may recommend the right ways of lifting weight or stop it altogether.
3. If the rectocele is caused due to constipation, the person will be advised to drink lots of water and include fiber rich ingredients in food.
4. If the person is overweight, he/she will be advised to workout regularly and lose weight before starting any procedure.
5. Chronic cough that puts pressure on the pelvis region must be treated promptly.

Medicines that may be given to manage / prevent rectocele:

1. Bowel softeners may be provided to people suffering from constipation.
2. Hormone Replacement Therapy (HRT) may be suitable for women who have the problem due to the lack of estrogen production.
3. A Vaginal pessary may be given to the patient advising on how to insert into the vagina to support the tissue between the rectum and vagina.

Surgical options to treat rectocele:

The surgeon will have an option to remove or repair the damaged tissue. Sometimes a plastic/specially made mesh may be used to support the wall between the vagina and rectum.

Ways to prevent rectocele

1. If the person had vaginal child births, she should make sure to strengthen pelvic muscles with regular workout including kegel exercise.
2. Overweight and obese patients should keep a tab on their weight and she the extra kilos of fat.
3. People suffering from constipation can see their physician for treatment.
4. If the person is lifting heavy weights, proper training needs to be given by an expert on right ways of lifting weights.

Many women suffer from prolapse and there is nothing to hide in it. Talk to your gynecologist before it gets severe and starts to interrupt the quality of your everyday life. Rectocele or any other prolapse is surely treatable and the quality of your life can be improved even after multiple vaginal child births. If you have further questions on prolapse and want to talk to our expert gynecologist at DG Laser & Cosmetic Gynecology Clinic, Dr. Deepa Ganesh, you can call us at +91 9317617693.

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967328/https://www.urologyhealth.org/urology-a-z/b/bladder-prolapse-(cystocele)
2. https://www.webmd.com/women/guide/prolapsed-bladder
3. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/gynaecology/pi-pelvic-organ-prolapse.pdf