What is a rectocele?

A rectocele occurs when the rectum (the lower part of the large bowel) bulges into the back vaginal wall, due to weakening of the supporting tissue. It is also known as a posterior prolapse. This page guides you to appropriate care and treatment that can help you manage this condition.

What are the symptoms of a rectocele?

It is possible to have a rectocele without noticing any problems. If you do have symptoms, they can include:

• a lump or bulge in your vagina
• needing to press your fingers on the vaginal bulge (‘splinting’) to help push the stool out when having a bowel movement
• constipation or difficulty in emptying the bowels completely
• pressure, heaviness or fullness in the pelvis that may feel like ‘bearing down’, or as though something is ‘falling out’
• ‘looseness’ in the vagina

The symptoms may get worse after a long day standing.

For some people, the symptoms of a rectocele are mild, but for others, they have a big impact on their life.

What causes a rectocele?

A prolapse is a bulge in the vagina. A rectocele, or posterior vaginal prolapse, is when the bulge is caused by part of the bowel. It happens when the thin wall of tissue between the vagina and rectum is weakened. This can happen in childbirth or anything else that puts pressure on the tissues in the pelvis.

Anything that weakens the muscles around the vagina or rectum can cause a rectocele.

Women who are pregnant, who have given birth or who have passed menopause are more likely than others to have a rectocele.

A rectocele can also be caused by:

• chronic constipation
• chronic cough
• being overweight or obese
• repeated heavy lifting

How is a rectocele diagnosed?

See your doctor if you have any symptoms. Your doctor will probably ask you about your symptoms and how they affect your daily life. Your doctor might conduct an internal pelvic examination, and might recommend an ultrasound. You might be referred to a specialist.

How is a rectocele treated?

Treatment depends on the severity of the rectocele.

If you have few symptoms, you might be encouraged to do pelvic floor exercises.

You might be able to reduce your symptoms by being active, drinking plenty of water and consuming enough fibre, which can help prevent constipation.

Your doctor might also recommend using a pessary, which is a plastic device inserted into the vagina to provide support.

Surgery might be recommended if your symptoms are troublesome. Surgical treatments include repair of the weakened tissues of the vagina, or the use of a mesh patch to support the wall between the rectum and vagina. Surgery can be done through the abdomen (trans-abdominal) or through the vagina (trans-vaginal).

Trans-vaginal mesh implants are no longer approved in Australia due to the high risk of complications. If your doctor thinks you need a trans-vaginal mesh implant, they need special permission. Make sure you understand the risks and benefits of this surgery.

Some women in Australia have experienced problems with the mesh used in surgery to treat rectoceles. Sometimes these complications can be very serious. If you have had mesh implanted and are experiencing symptoms like bleeding or pain, see your doctor. You can find out more about transvaginal surgical mesh on the Therapeutic Goods Administration website.