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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

  • Anorectal/vaginal pain

  • Fecal soiling

  • Vaginal/perineal bulge

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:

  • Chronic constipation

  • Menopause

  • Older age

  • Vaginal delivery

  • Multiple pregnancies

  • Perineal tearing

  • 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-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:

For providers, check out our online courses to help your clients. Consider joining our Ambassador Program and most of our courses are included with your membership!

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.


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