A rectocele presents as:

Urogenital

There may be a bulge or palpable mass in the vagina which may partially obstruct the vaginal canal causing pain during intercourse, vaginal bleeding and difficult labor. There may also be persistent pain in the pelvic cavity which increases during defecation and is slightly relieved after fecal evacuation.

Gastrointestinal

Patients suffering from a rectocele may often complain of constipation, difficulty in evacuation, straining, the need to press against the vagina or near the rectum to be able to evacuate, a feeling of incomplete evacuation and pain. Fecal incontinence may also occur as well as rectal prolapse from the anus.

• Weakness

  It is traditionally considered a posterior compartment damage with weakness of posterior vaginal wall support resulting in a bulging of the rectum into the vaginal cavity. [ncbi.nlm.nih.gov]

  Outcomes and further sources of support Because of inherent weakness, these problems can return following surgery and further procedures may be required. [bowelcancerresearch.org]

  This area is called the rectovaginal septum and may be a weak area in the female anatomy. Other structures may also push into the vagina. The bladder bulging into the vagina is called a cystocele. [evergreenhealth.com]

• Falling

  Loss of support lets pelvic organs fall out of their normal position. This is called prolapse. If the rectum falls out of place and bulges into the vagina, it is called rectocele. [saintlukeskc.org]

  […] down" or "falling out" within the pelvis. [en.wikipedia.org]

• Surgical Procedure

  A surgical procedure called anterior colporrhaphy tightens the front walls of the vagina, while posterior colporrhaphy tightens the back walls. [my.clevelandclinic.org]

  Of course, it may be safe to perform a surgical procedure under spinal anesthesia with a transvaginal, transanal, or transperineal approach in elderly patients or those with significant medical comorbidities. [e-jmis.org]

  CONCLUSIONS: The 2 surgical procedures obtain good results with 80% of satisfied patients with a length of stay a little shorter in the STARR. [ncbi.nlm.nih.gov]

  The surgical procedure To correct a rectocele, the rectum is moved back to its normal position. The tissue between the vagina and rectum is stitched (sutured) to strengthen it. This stops the rectum from bulging into the vagina. [saintlukeskc.org]

• Fever

  You develop a fever. You have heavy bleeding from your vagina. Call the doctor during office hours if: You have questions about the procedure or its result. You want to make another appointment. Our phone number is (304) 388-1900. [camc.org]

  Call our emergency number at any time if: You have a fever over 100 F (37.8 C). You have heavy bleeding from your vagina. The catheter becomes plugged and you stop passing urine. [greenvilleob.com]

  Please call us if you have a fever over 100.5 F consistently at home, pain that worsens or is not controlled by medicines, excess discharge or concerns for wound infection, heavy vaginal bleeding or discharge, nausea or vomiting, leg pain or swelling, [sclhealth.org]

  Call Contact your doctor if your recovery is not progressing as expected or you develop complications such as: Signs of infection, including fever and chills Excessive bleeding or any discharge from the incision site Unusually heavy vaginal bleeding or [wnyurology.com]

• Swelling

  Our case was admitted with complaints of a swelling in her vagina, constipation, and difficulty in emptying her bowels. The diagnosis and treatment utilizing transvaginal approach in this case is discussed in comparison with the literature. [ncbi.nlm.nih.gov]

  Eight women presented with some complaint of stool trapping, constipation, anal swelling and bright red blood per rectum. Rectocele and grade 3–4 hemorrhoids were diagnosed based on the history, physical examination, colonoscopy and defecography. [link.springer.com]

  Please call us if you have a fever over 100.5 F consistently at home, pain that worsens or is not controlled by medicines, excess discharge or concerns for wound infection, heavy vaginal bleeding or discharge, nausea or vomiting, leg pain or swelling, [sclhealth.org]

  The swelling of the rectum wall might increase during bowel movement. Rectocele makes the rectovaginal wall weak and thin. How is Rectocele graded? Rectocele is graded according to the degree of its inclination into the vagina of women. [howshealth.com]

• Sneezing

  I can now sneeze, lift children, and have less urgency than before. I would highly recommend this surgery. Margaret W, Calgary AB [drdavidwilkie.ca]

  Further tests If you have bladder symptoms, such as needing to rush to the toilet or leaking when you cough and sneeze, further tests may need to be carried out in hospital. [everestpharmacy.co.uk]

  […] of the pelvic floor include: To support the pelvic organs, specifically the uterus, the bladder, and the rectum To help provide sphincter control for the bladder and bowel To withstand increases in pressure that occur in the abdomen such as coughing, sneezing [advanced-trainings.com]

  Certain muscles in the pelvic floor help resist the increased pressure in the pelvis that happens when, for instance, a person coughs, sneezes, or vomits. [verywellhealth.com]

  In more serious cases, the symptoms of cystocele include: Urine leakage while laughing, sneezing, or coughing Incomplete bladder emptying after urination Pain or pressure in the pelvis Pain during sexual intercourse Feeling of tissue bulging out of vagina [lahey.org]

• Constipation

  If you suffer from chronic constipation, then I strongly advise you to get my book, Listen To Your Colon: The Complete Natural Healing Guide For Constipation, as you need a comprehensive constipation treatment that addresses all of the variables. [blog.listentoyourgut.com]

  OBJECTIVES: Rectocele with constipation might be related to methane (CH4) producing intestinal bacteria. We investigated the breath CH4 levels and the clinical characteristics of colorectal motility in constipated patients with rectocele. [ncbi.nlm.nih.gov]

• Rectal Pain

  Rectal pain Difficulty controlling the passage of stool or gas from the rectum Low back pain that is relieved by lying down. [spokesman.com]

  OBJECTIVES: Large rectoceles (>2 cm) are believed to be associated with difficulty in evacuation, constipation, rectal pain, and rectal bleeding. [ncbi.nlm.nih.gov]

  pain, vaginal bleeding, pain during vaginal intercourse, or a sense of fullness in the vagina. [pcrsurgeons.com]

• Diarrhea

  In women who are having difficulty with bowel movements, correction of diarrhea or constipation with a bulk fiber product often helps considerably. [lacolon.com]

  You can stop taking it if you have diarrhea (loose or watery bowel movements) Follow-up Make an appointment to see your doctor 2 weeks after your surgery. Don’t lift anything heavier than 10 pounds for 3 months after your surgery. [mskcc.org]

  This is mostly due to the problems such as diarrhea and constipation that accompany IBS. A lot of people who suffer from Rectocele find that IBS often accompanies it. Talk about a double bummer! [angiesdiary.com]

• Prolapse

  Natural Treatment for Rectal Prolapse Treating the underlying causes of rectal prolapse usually cures the problem. [blog.listentoyourgut.com]

  If there are other associated problems (eg. prolapse higher up in the vagina), a laparoscopic operation through the abdomen may be more appropriate. [oxfordgynaecology.com]

  Risk factors for vaginal wall prolapse are Age Obesity Vaginal delivery Severity of vaginal wall prolapse can be graded by the Baden-Walker system, which is based on level of protrusion: Grade 0: No prolapse Grade 1: Halfway to the hymen Grade 2 : To [merckmanuals.com]

  Rectal prolapse is when rectal walls have prolapsed to the degree they protrude through the anus and are visible outside the anal canal. Frequently patients with rectal prolapse have fecal incontinence. [pelvicorganprolapsesupport.org]

  Common symptoms include symptoms of prolapse and obstructed defecation. AIMS: To describe subjective, anatomical and functional results of defect-specific rectocele repair. [ncbi.nlm.nih.gov]

• Irritability

  All patients were questioned for constipation, fecal incontinence, and irritable bowel syndrome and were assessed with dynamic perineal ultrasonography and conventional anorectal manometry. [ncbi.nlm.nih.gov]

  Home All Ages Children Young Adults Adults Older Persons Illness Bladder cancer Bladder stones Cystitis Kidney disease Overactive bladder Bowel cancer Colitis Crohn's disease Diverticulosis and diverticulitis Haemorrhoids Irritable bowel Kidney cancer [bladderbowel.gov.au]

  Vaginal symptoms include vaginal bulging, the sensation of a mass in the vagina, pain with intercourse or even something hanging out of the vagina that may become irritated. [evergreenhealth.com]

  Anal irritation including pain, itching and bleeding. Red tissue that extends out of the anus. What can be done? Avoid constipation. Simple changes can improve or reverse a partial prolapse. [kegel8.co.uk]

• Dyspareunia

  None of the patients encountered de novo dyspareunia after the procedure. CONCLUSION: Anterolateral rectopexy provides an effective tool for anatomical correction of rectoceles and does not result in dyspareunia as a side effect. [ncbi.nlm.nih.gov]

• Vaginal Bleeding

  A rectocele presents as: Urogenital There may be a bulge or palpable mass in the vagina which may partially obstruct the vaginal canal causing pain during intercourse, vaginal bleeding and difficult labor. [symptoma.com]

  Symptoms of rectocele can include the following: Problems with using bowel Faecal incontinence Pain in the lower back Pain in the lower abdomen Pain whilst having intercourse, or Vaginal bleeding (not related to the menstrual cycle). [bladderbowel.gov.au]

  You may have some vaginal bleeding after surgery. Wear a pad or panty liner. Don’t use tampons. You can shower 48 hours after your surgery. Don’t take tub baths, go swimming, or sit in a hot tub until your doctor or nurse says it’s safe. [mskcc.org]

  Severe cases may cause vaginal bleeding, intermittent fecal incontinence, or even the prolapse of the bulge through the mouth of the vagina, or rectal prolapse through the anus. [dictionnaire.sensagent.leparisien.fr]

  Light vaginal bleeding can occur as the incision heals and some discomfort with bowel movements is normal, initially. Other risks, common to all pelvic surgery, include the possibility of clot formation in the legs or lungs. [sclhealth.org]

• Urinary Retention

  Among the early complications, 3 patients reported pain (12 %), 3 patients urinary retention (12 %), and 2 patients bleeding (8 %). [ncbi.nlm.nih.gov]

  Retention Urinary incontinence Urinary tract infection - chronic or recurrent Urogenital Fistula Uterine prolapse Vaginal Enterocele Vulvodynia female urinary tract injury consultation Procedures Performed Autologous fascia slings Bladder Botox Injections [lluh.org]

  The possible risks of the surgery are: Bleeding Infection Urinary retention Damage to bowel Pain with intercourse Difficulty with bowel movements Failure of the surgery Accidental damage to vagina, rectum, and bladder Accidental damage to nearby organs [innovateus.net]

Rectoceles are usually found during routine physical examinations because the majority of them are asymptomatic.

A defecography, which is a special procedure in which a contrast medium is inserted into the rectum as an enema, and then x-rays are taken during bowel movement, is an accurate test to diagnose a rectocele [3].

Test Results

The results of a defecography are diagnostic. This test also shows the size, exact location and degree of obstruction of the rectocele.

Rectoceles are only treated if they present with significant symptoms. Treatment depends upon the severity of the condition. It is of two types: Conservative and Surgical.

Conservative Treatment

Rectoceles are conservatively treated by a controlled high fiber diet. By supplementing high fiber cereals and fiber bars into the diet along with an increased water intake, bulk is increased. This may be accompanied with stool softeners to help in evacuation and to lessen straining during defecation [6]. A hormone replacement therapy may also be started in post menopausal women to replenish the level of oestrogen to help with muscle strength. Pelvic floor muscle exercises, known as Kegel exercises, may be carried out to increase muscle power and strength.

Surgical Treatment

Surgical repair can be done either by suturing up the tears in the vaginal wall or by inserting a mesh or patch to support and strengthen the tissues. Often the tissue from the rectocele itself is removed and used for patching up the tears. Repair of the rectovaginal septum can also be carried out [1].

It should be noted that surgical repair is carried out only if conservative management has totally failed or if the rectocele is so enlarged that it is causing a significant reduction in quality of life [5].

Rectoceles if mild, usually do not require any treatment as they do not present with any symptoms. In such cases, the affected female is usually unaware that she has a rectocele [7].

Mild cases may remain mild, content in staying in a 'latent' stage. But if the underlying cause is not removed or treated, some may progress to becoming symptomatic.

In cases of moderate and symptomatic to severe rectoceles, treatment is needed to alleviate the symptoms.

Complications

Complications are rare but if left untreated, a rectocele may result in vaginal bleeding, dyspareunia, obstructed labor, rectal prolapse through anus and general discomfort due to incomplete bowel emptying [8].

Rectocele in women is a common condition and can be due to a number of factors. Some of which are mentioned below:-

Childbirth

This is the most common cause of a rectocele. During childbirth, there is increased strain on the pelvic floor muscles and the rectovaginal septum leading to their weakness. Particularly during birthing of a child weighing 8-9 pounds or more, the weakened muscles and fascia result in a wide, dilated and weakened vaginal wall. This allows the rectum to bulge forward into the vaginal canal, creating a rectocele. The more vaginal deliveries a women has, the more the chance of developing a rectocele.

Delivery procedures

This cause of developing a rectocele is slightly different from childbirth. During delivery, if the person performing the operation is not an appropriately trained professional, as in many rural areas of 3rd world countries, or if there is malpractice, for example the wrong use of forceps to pull the baby out, vacuum delivery, episiotomy during vaginal delivery, etc. there may be tearing of the muscles. The tearing may be on the vaginal wall itself, or sometimes on the supporting muscles and fascia. Either way, the rectum can push through the openings, into the vagina.

Pelvic surgery

During surgical procedures of the pelvic cavity, such as a hysterectomy, the surrounding fascia may be damaged. Or after a hysterectomy, the muscles of the pelvic floor may become weak and lead to a rectocele [10].

Bowel disturbance

Long standing constipation causes undue straining of the pelvic muscles during defecation. This results in weakening of the pelvic floor muscles which are then unable to support the rectum and vagina, resulting in a rectocele.

Old Age

As women age, they no longer have a sufficient supply of estrogen to maintain the elasticity of the pelvic muscles. As a result rectoceles, cystoceles and other pelvic organ prolapse may occur.

The exact epidemiology of rectocele can not be calculated as many women who have this condition do not come forward, and many others have it in such a mild form that they do not know they have it [9].

Race

A study reveals that white women are at greater risk of developing a rectocele and pelvic organ prolapse than women of African-American origin [2].

Age

It is more prevalent in older aged women.

Sex

Rectoceles are much more common in females than in males.

Incidence

According to the results of the Women's Health Initiative Study, 41% of females showed some degree of pelvic organ prolapse between 50-80 years of age. Out of this, 19% had a rectocele.

The rectovaginal septum, sometimes also known as the Fascia of Otto, is a thin sheet-like fibrous band of connective tissue that covers the vaginal wall posteriorly and the rectum anteriorly. It's function is to separate the two structures and give them support [4].

If due to any reason as stated in the previous section, this septum is damaged or weakened, the rectum may start bulging forward, into the vagina. Sometimes, damage to the septum only may not lead to a rectocele but a torn septum along with weakened pelvic muscles may cause a rectocele to develop.

Rectoceles can be prevented by taking a high fiber diet and large quantity of water to help soften stools. Kegel exercises to strengthen muscles and hormone replacement therapy after menopause open link should be begun to prevent pelvic organ prolapse.

A rectocele is a defect in the rectovaginal tissue or septum which results in bulging of the anterior wall of the rectum into the vagina. This condition is similar to a hernia where rectal tissue protrudes into the vaginal canal.

The rectum and the vagina are separated from each other by a tough, fibrous band of tissue called the rectovaginal fascia or septum. This sheet like septum serves to not only separate the two structures but to also lend support to the vaginal wall. If due to any reason, this layer gets damaged, weakened or lacerated, a portion of the anterior wall of the rectum bulges forward and into the posterior wall of the vagina.

This condition is usually asymptomatic in most females, however, in moderate to severe cases, patients may complain of constipation, a bulge or mass in the vagina, difficulty in evacuation, pain in the rectum and pain during intercourse.

Rectocele occurs in males too, but since the prostate gland gives support anteriorly, the herniation of the rectum happens posteriorly through the rectoprostatic fascia or septum. It should be noted that rectocele is a very rare occurrence in males.
On the contrary, a rectocele is a very common condition in females and that is why, this article is based on occurrence of this condition in females only.

Definition

Rectocele is a bulge of a portion of the rectum into the vagina due to weakened supporting muscles in the pelvis.

Cause

It may be due to childbirth, old age, prolonged constipation, pelvic surgeries, etc.

Signs and Symptoms

Mild cases are asymptomatic. Moderate to severe cases present with pelvic pain, constipation, straining and difficulty in evacuation, a bulge or mass in the vagina, pain during intercourse and vaginal bleeding.

Treatment

A rectocele can be treated conservatively by a change in diet, HRT and stool softeners. Surgical treatment includes suturing up of vaginal wall or supporting muscles and mesh repair.

Prevention

Rectocele development can be prevented with a high fiber diet, Kegel exercises and hormone replacement therapy after menopause.

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