In this article, we explain what a rectocele is, what the typical symptoms are, and why a woman may develop one.
As we have seen in the introductory page of this section, there can be multiple causes of constipation. Some are obvious and can be easily traced: the consumption of opiate medications for instance.
Some are a little more obscure and require precise diagnosis by your doctor. A rectocele belongs to the latter.
Second, we will discuss how a this condition can impact your bowel movements, and trigger constipation crises.
Finally, we will discuss the possible solutions, ranging from a simple and non-invasive approach to a surgical intervention. As we will see, managing constipation to avoid a worsening of the problem will be essential.
It is one particular type of “pelvic organ prolapse”. A pelvic organ prolapse is the abnormal drop or herniation of one of the organs in the pelvis from its normal position.
The organs concerned are the vagina and the rectum. Between those two organs, we have a layer of connective fibrous tissues (also called a fascia). This layer keeps the two organs well separated. When this layer becomes weakened due to causes we will discuss further down, the rectum can develop a bulge that exerts pressure against the back wall of the vagina.
See the two pictures below, the one on top depicting a normal pelvic organ configuration, and the one below showing an abnormal one.
Pelvis - Normal Configuration
Pelvis with Rectocele
The bulge can be of different sizes, and can push at different points (high or low) on the vaginal wall. A low rectocele bulges toward the lower part of the vagina, near the vulva. A high one bulges toward the higher part of the vagina, away from the vulva.
A grading scale is used to denote how large the problem is is. Grade 1 makes reference to a small bulge, and grade 3 being the largest type, with a significant bulge pushing into the vagina’s space. The one shown on the second picture would be more of a type 3.
There are several reasons why the fascia separating the rectum from the vagina becomes weaker.
The direct causes may be:
The indirect causes may be:
Even though constipation may be a cause of rectocele, it will more likely be an aggravating factor. You may have gone through several vaginal childbirths, which created weaknesses in the fascia and initiated a rectocele, maybe unnoticed at that point. Then, chronic constipation may have made the condition worse, it may have enlarged the bulge.
According to the American Society of Colon & Rectal Surgeons(2), many women suffer from this condition but only a small percentage of women will feel any symptoms.
Those symptoms may be:
Please note that having some of those symptoms does not necessarily mean you have the condition. You should discuss your particular situation with your doctor.
Your doctor will first do a vaginal and rectal examination. In a second step, he or she may ask you to do a defecography, which will provide details on your bowel evacuation pathways, and will help determine the size and severity of the problem.
For a small grade 1 version, you may have several non-surgical options open to you:
For a large version, your doctor may suggest surgical intervention. Repair surgery is regarded as safe and its success rate is high. It is an inpatient intervention, and may be done under local or general anesthesia.
Surgery may be performed through the vagina, through the rectum, or through the zone situated in-between (the perineum)(2). A synthetic mesh may be inserted in order to strengthen the weakened zone between the vagina and the rectum.
Both colorectal surgeons and gynecologists are familiar with this type of repair surgery. If your symptoms are mostly vaginal, your gynecologist may be performing the intervention. If your symptoms are more rectal, or if you have other rectal issues to deal with such as hemorrhoids, your colorectal surgeon will perform the intervention.
You may want to seek opinions from both specialties to make sure you have covered all options.
After the surgery, you will have to work on keeping regular and soft bowel movements. This website is of course here to help you achieve that goal.
Recovery time varies from person to person, but overall it should take from 4 to 6 weeks. During recovery, you should rest, avoid lifting heavy objects, refrain from driving and from sexual intercourse, and keep an eye on your diet to avoid constipation.
In this article, we have discussed a condition called rectocele. You may be interested in this condition for three reasons.
First, you may suffer from chronic constipation, and are at a loss trying to find the underlying cause. This article should help you determine whether you fit the profile and symptoms described above. If yes, you should consult with your medical team to reach a diagnosis.
Second, you may have been told that you have a small rectocele. You want to get more familiar with this condition. You have also been told by your doctor that you should avoid constipation to keep it small and stable. This website will definitely allow you to achieve that goal.
Third, you may have been told you have a large one. You want to actively prepare for the post-surgery period, make sure your bowel movements will stay soft and regular, and lower the risk of recurrence in the future. Here again, this website should not fail you.
(1) Lowe DA, Baltgalvis KA, Greising SM. "Mechanisms behind estrogen's beneficial effect on muscle strength in females." Exerc Sport Sci Rev. 2010 Apr;38(2):61-7. Review.
(2) American Society of Colon & Rectal Surgeons, rectocele information page.
(3) Beck DE, Allen NL. "Rectocele." Clin Colon Rectal Surg. 2010 Jun;23(2):90-8.
(4) Mimura T, Roy AJ, Storrie JB, Kamm MA. "Treatment of impaired defecation associated with rectocele by behavorial retraining (biofeedback)." Dis Colon Rectum. 2000 Sep;43(9):1267-72.
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