rectocele

A rectocele is a type of pelvic organ prolapse in which the front wall of the rectum protrudes into the back wall of the vagina. It results from weakness or damage to the pelvic floor muscles and connective tissues that support the rectum and vaginal walls. The condition is more common in women and can develop after childbirth, aging, menopause, or prior pelvic surgery.

Risk factors include vaginal delivery, multiple pregnancies, chronic constipation with repeated straining, obesity, heavy lifting, connective tissue disorders, and radiation or surgery in the pelvic area. Some women have no identifiable cause or only mild weakening.

Symptoms vary and may include a sensation of pressure or fullness in the pelvis, a bulge in the vagina, difficulty with bowel movements, the feeling of incomplete evacuation, needing to push on the vaginal wall to aid defecation, or discomfort during intercourse. Some rectoceles cause little or no symptoms.

Diagnosis is typically made by a pelvic examination. In some cases, special imaging tests such as defecography or dynamic MRI are used to assess the size of the prolapse and its effect on bowel function or to distinguish rectocele from other prolapses or anorectal conditions.

Treatment is tailored to symptom severity. Many cases are managed conservatively with pelvic floor physical therapy, a high-fiber diet and adequate fluids, stool softeners, abdominal or vaginal pessaries to provide support, and avoidance of activities that worsen symptoms. Hormonal therapy may be considered for postmenopausal women to improve tissue quality.

Surgical options are considered for more pronounced or persistent prolapse. Procedures include posterior colporrhaphy (native tissue repair), perineorrhaphy, and, in select cases, abdominal approaches such as rectopexy. Mesh-augmented repairs exist but carry additional risks. Outcomes vary, with potential for recurrence and complications such as constipation or dyspareunia.