Diseases & Conditions

Rectocele

A rectocele occurs when the fascia — a wall of fibrous tissue separating the rectum from the vagina — becomes weakened, allowing the front wall of the rectum to bulge into the vagina.

Childbirth and other processes that put pressure on the fascia can lead to a rectocele. Generally, rectoceles occur after menopause, when estrogen — which helps keep your pelvic tissues strong — decreases.

A small rectocele may cause no signs or symptoms. If a rectocele is large, it may create a noticeable bulge of tissue through the vaginal opening. Though this bulge may be uncomfortable, it's rarely painful.

When treatment of a rectocele is necessary, self-care measures and other nonsurgical options are often effective. In severe cases, you may need surgical repair.

In most cases, your doctor can confirm a diagnosis by physical examination of the vagina and rectum.

During the exam, your doctor may ask you to bear down as if having a bowel movement. This may cause the rectocele to bulge, so your doctor can assess its size and location. To check the strength of your pelvic muscles, you may also be instructed to contract them, as if you are stopping the stream of urine.

If anything found during the physical exam seems unrelated to your symptoms, your doctor may want you to undergo an imaging test, such as magnetic resonance imaging (MRI) or an X-ray exam, to determine the size of the rectocele and how efficiently your rectum empties (defecography). Otherwise, imaging tests are rarely needed to diagnose a rectocele.

Depending on the severity of the condition, self-care measures may provide the relief you need.

Self-care measures you can take:

• Perform Kegel exercises.
• Avoid constipation by eating high-fiber foods and drinking plenty of fluids.
• Avoid heavy lifting.
• Try to control coughing.
• Lose weight if you're overweight or obese.

Kegel exercises
Kegel exercises, designed to strengthen your pelvic floor muscles (including your fascia), can help both prevent and treat a rectocele. To perform Kegel exercises:

• Pull in your pelvic floor muscles — the muscles you use to stop urinating.
• Hold them for a count of five and then relax for a count of five.
• Work up to 10 to 15 repetitions at a time.
• Repeat three times daily.

Kegel exercises may be most successful when they're taught by a therapist using biofeedback. Biofeedback uses information from a variety of (pain-free) monitoring devices to help teach you to control certain involuntary body responses, such as muscle tension. In this case, biofeedback can help ensure you're contracting the proper muscles, and that the intensity and duration of the muscle contractions are optimal.