A rectocele is a condition in which the rectum, the last part of the large intestine, bulges (prolapses) toward the back wall of the vagina as a result of a weakening of the pelvic floor support. This condition arises with the weakening of the pelvic floor muscles and connective tissues.
A rectocele is seen more frequently especially in women who have given birth vaginally, those with a history of difficult delivery, and in the post-menopausal period. It is a condition that can progress over time, and its most important effect is that it impairs bowel function.
Causes
A rectocele usually develops due to pelvic floor weakness:
Factors related to childbirth
- Vaginal deliveries
- Difficult and prolonged deliveries
- A history of multiple births
- Pelvic floor damage during delivery
Age-related changes
- Tissue weakening after menopause
- Loss of collagen
- A decrease in muscle tone
Other risk factors
- Chronic constipation and constant straining
- Heavy lifting
- Obesity
- Chronic cough
Symptoms
In rectocele patients, the most common complaints are related to bowel emptying:
Defecation problems
- Constipation
- Straining during defecation
- The need to stay in the toilet for a long time
- A feeling of incomplete emptying
Mechanical symptoms
- A feeling of fullness or pressure in the vagina
- The need to provide support with a finger inside the vagina to facilitate defecation
- Discomfort in the pelvic area
Advanced symptoms
- Constipation that affects social life
- A chronic feeling of pelvic pressure
- Discomfort during sexual intercourse
Diagnostic Methods
The diagnosis of a rectocele is usually made with a clinical evaluation:
Physical examination
- Gynecological examination
- Pelvic floor evaluation
Imaging
- Defecography (imaging during defecation)
- Pelvic MR evaluation
- Rectal examination and endoscopic investigation if necessary
Treatment Methods
Treatment is planned according to the severity of the disease and the patient’s quality of life:
Conservative treatment
- A fiber-rich diet
- Plenty of fluid intake
- Prevention of constipation
- Pelvic floor exercises (Kegel)
- Regulation of toilet habits
It can be quite effective in mild and moderate cases.
Supportive methods
- Bowel-regulating medications
- Pelvic floor physiotherapy
- Lifestyle changes
Surgical treatment
- Rectovaginal septum repair
- Pelvic floor reconstruction
- Correction of accompanying other pelvic organ prolapses
In severe rectocele, surgical treatment is the most effective permanent solution.
The Importance of Rectocele
An untreated rectocele can lead to:
- Chronic constipation
- Defecation disorders
- A serious decline in quality of life
- The progression of pelvic organ prolapse
- Psychological discomfort
Frequently Asked Questions
Is a rectocele dangerous?
It does not pose a life-threatening risk, but when it progresses, it is a condition that seriously impairs quality of life.
Does a rectocele go away on its own?
No. It is usually a progressive condition, and complaints can increase over time.
Is surgery essential?
In mild cases, diet and exercise may be sufficient. In advanced cases, surgical treatment is needed.
Does a rectocele cause constipation?
Yes. The most common symptom is difficulty with defecation and constipation.
Does it recur after surgery?
With appropriate technique and lifestyle adjustments, the risk is low, but it is not completely zero.
Do pelvic exercises work?
Yes. They can reduce symptoms, especially in early-stage rectocele.
Does a rectocele affect sexual life?
Yes. It can affect it due to pelvic fullness and discomfort.
Does it occur after childbirth?
Yes. It can develop with pelvic floor weakening, especially after vaginal delivery.
Does a rectocele progress?
Yes. If left untreated, its degree can increase over time.
Is a lifestyle change enough?
In mild cases yes, but in advanced cases surgery may be needed.
Clinical Summary
A rectocele is the prolapse of the rectum toward the back wall of the vagina due to pelvic floor weakness. Its most important effect is that it impairs bowel function. It can be brought under control with conservative methods in the early period, and in advanced cases, successful results are achieved with surgical treatment.
