Hello friends! Let’s face it--medical words can be big, scary, and confusing. This week we are going to talk about three medical conditions that sound similar but are different: rectocele, rectal prolapse, and rectovaginal fistula.
A rectocele is a type of pelvic organ prolapse involving the rectum. A rectocele is caused by damage to the tissues that support the rectum. This causes the rectum to fall downward into the vaginal wall (Bo, 2015).
A rectocele can often be treated with nonsurgical options. Surgery may be indicated if these approaches are not successful in managing symptoms (Bharucha, 2022). Avoiding straining by managing constipation with diet and using a technique called perineal splinting can help with rectocele symptoms and prevent it from getting worse. The Femmeze is a tool that can be used to help with internal splinting. Strong pelvic floor muscles can help to support the rectum and lift it.
Rectal prolapse describes the tissue of the rectum dropping out of the anus (Bordeianou, 2014)
Rectal prolapse can cause pain, difficulty with complete pooping, bloody and/or mucous rectal discharge, fecal incontinence (uncontrolled loss of gas or poop), or constipation (Bordeianou, 2014).
For rectal prolapse that causes moderate to severe symptoms, surgery is often indicated (Bordeianou, 2014). However in some cases, non-surgical treatments can be adequate. These treatments can include adequate fiber and water intake, pelvic floor muscle training, and avoiding straining with bowel movements.
Rectovaginal fistulas are a hole that connects the anal canal with the vaginal canal (Vogel, 2016). A warning sign of a fistula is gas and/or stool leaking from the vagina. Note that this is different than air that may get trapped in the vaginal canal and cause the same sound as gas but this air does not have an odor. Air in the vaginal canal is often referred to as a “queef.”
Rectovaginal fistulas can be caused by infection, birth-trauma, radiation, cancer, or pelvic surgery (Vogel, 2016). Treatment for a rectovaginal fistula depends on the size of the fistula as well as the cause. If non-surgical treatment is indicated, wound care, sitz baths, and the use of stool-bulking fiber supplements is recommended (Vogel, 2016).
Regardless of the condition, keeping stool at an optimal consistency, having good bowel habits, and strengthening the pelvic floor is important in symptom management.
A squatty potty helps to relax the pelvic floor muscles to allow stool to leave the body easier. Drinking lots of water and taking in fiber can help ensure soft, squishy poop to pass easily. While fiber is best when taken from whole food sources, this can be difficult to achieve on a daily basis. If this is the case, supplements like psyllium and flaxseed can be beneficial.
A pelvic floor therapist can help ensure your pelvic floor muscles are working optimally in order to support the rectum and the rest of the pelvic organs as well as to allow poop to exit the body easily without straining. To find one near you, ask your providers for a referral or find one online at www.mypfm.com/find-a-pt.
Ready to learn more about your pelvic floor muscles? Here are some helpful resources:
The Role of Probiotics & How to Support the Gut Microbiome for Digestive Disorders with Erin Judge, RDN, LDN
Gut Health Q&A with Dr. Will Bulsiewicz, MD, MSCI
Pelvic Floor Rehabilitation for Inflammatory Bowel Disease with Dr. Amanda Olson, PT, DPT, PRPC
Written by Emily Reul, PT, DPT
Bharucha AE, Knowles CH. Rectocele: incidental or important? observe or operate? contemporary diagnosis and management in the multidisciplinary era. Neurogastroenterol Motil. 2022;34(11):e14453.
Bo K, Berghmans B, Morkved S, Van Kampen M. Evidenced-based physical therapy for the pelvic floor bridging science and clinical practice. 2nd edition. 2015.
Bordeianou L et al. Rectal prolapse: an overview of clinical features, diagnosis, an patient-specific management strategies. J Gastrointest Surg. 2014;18(5):1059-69.
Vogel et al. Clinical practice guideline for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum. 2016;59:1117-1133.