What is a Rectocele?
Hi friends! Have you ever heard of a rectocele? What about pelvic organ prolapse? A rectocele is actually a type of pelvic organ prolapse. It is a sac-like bulging of the wall of the rectum either towards the vagina (or rarely towards the sacrum). This week we are going to talk about the causes and the treatments for a rectocele.
Two in ten of women have rectocele, but most are small and can have no symptoms which does not require treatment (Schey, 2012). If a rectocele does cause symptoms, they are often most apparent when pooping but can happen at any time (Schey, 2012). Symptoms can include:
Feeling of incomplete emptying after pooping
Straining or needing to vaginally splint when pooping
Pain with sex
Note: A rectocele is different from a rectovaginal fistula. With a rectocele, the vaginal wall stays intact, but with a fistula a hole forms. With a fistula, you may notice poop or discharge coming from the vagina. It is important to see your provider if you have a fistula.
There are a wide variety of causes for a rectocele, or other types of pelvic organ prolapse. It can have a genetic component like hypermobility and connective tissue disorders (i.e. Ehlers Danlos). Other causes can be:
Long pushing during labor and delivery
Regardless of the cause of your rectocele, there is hope! The first line of treatment recommended is pelvic floor muscle training. Training with a pelvic floor physical therapist will not only help you to strengthen the pelvic floor muscles and support from below, but will help you understand how to manage pressure coming from above. This along with other treatments like fiber supplements, laxatives, and timed toilet training may be helpful (Schey, 2012).
Ask you doctor for a referral to a pelvic floor physical therapist near you, or find a therapist on your own. Head to www.mypfm.com/find-a-pt to search 4 free databases for a provider.
If the rectocele is present because of chronic straining with constipation, it is important to address the constipation. This may be through biofeedback and pelvic floor muscle coordination training to help the pelvic floor muscles relax, or it may be with fiber supplements and laxatives. Remember to talk with your provider before adding or changing any medications or supplements—even if they are over-the-counter.
Surgery to repair a large rectocele or coexisting vaginal prolapse may be recommended by your doctor, but it should only be recommended after conservative treatments do not work (Schey, 2012).
To learn more about your pelvic floor muscles, check out these great resources:
Watch our Bowel Health and Your Pelvic Floor YouTube playlist
Watch our Prolapse and the Pelvic Floor YouTube playlist
Subscribe to access our video courses on demand at Pelvic Flicks and check out the Power Over Prolapse Course
Learn more about your pelvic floor on our Instagram
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Pelvic Floor Rehabilitation for Inflammatory Bowel Disease with Dr. Amanda Olson, PT, DPT, PRPC
Hypermobility and the Pelvic Floor with Dr. Linda Bluestein, MD
The 3D Pelvis with Hayley Kava, PT, MPT, Pelvic Floor Physical Therapist
Written by Emily Reul, PT, DPT
Schey R, Cromwell J, Roa SSC. Medical and surgical management of pelvic floor disorders affecting defecation. Am J Gastroenterol. 2012;107(11):1624-1634.