What is a rectocele?
A rectocele is a forward bulging or displacement of the rectum into the vagina. This creates a pouch into which stool can accumulate and become trapped, often causing difficulty in initiating or completing a bowel movement. Patients with this condition often describe having to push or ‘splint’ inside or near their vagina in order to complete a bowel movement.
What causes a rectocele?
A rectocele is caused by a weakening of the tissue between the rectum and vagina. This allows the wall of the rectum to push forward against the back wall of the vagina. Weakening of this rectovaginal wall occurs due to a combination of aging, and pelvic floor stretching from childbirth. Rectoceles may be seen in younger women after difficult or multiple deliveries.
Do all rectoceles need to be repaired?
Many women will have small or even larger rectoceles that do not cause symptoms. As long as bowel movements are occurring normally, a rectocele does not need to be repaired. In women who are having difficulty with bowel movements, correction of diarrhea or constipation with a bulk fiber product often helps considerably.
In those women who continue to have difficult bowel movements, as described above, surgical repair of the rectocele will often be beneficial. The operation involves strengthening the weakened wall between the rectum and vagina. Depending on a variety of factors, your surgeon may recommend a repair of the rectocele through the rectum, or through the vagina. Both of these repairs are done as outpatient procedures.
Many women with rectoceles also have associated bulging of their bladders (cystocele) or small intestines (enterocele) into their vagina. Before an operation is planned, a test called defecography is usually performed to determine if these other conditions need to be repaired as well. In this test, a barium paste is placed into the rectum, and x-rays are taken of the rectum at rest and during passage of the barium. Often, an oral contrast dye is also given during the test, in order to detect associated prolapse of the small intestine.
A successful repair can dramatically improve the quality of life of those patients with a symptomatic rectocele or enterocele.
Your physician will have a thorough discussion with you regarding all of the available options as well as of the risks and benefits of an operative repair.