18 March 2019 The pressure exerted by this wall on the rear wall of the vagina causes it to bulge into the vagina. The rectocele may be isolated: that is, it may not be associated with any other pathology. However, it could be part of a situation of widespread weakness of the pelvic floor and coexist with other conditions such as: Cystocele; Urethrocele and/or enterocele; Uterine or vaginal prolapse; Rectal prolapse; Faecal or urinary incontinence. What causes a rectocele? The rectocele is the result of weakness in the structures supporting the pelvic floor and rectovaginal septum (a septum separating the rectum from the vagina, formed by the front wall of the rectum and the rear wall of the vagina). It can occur at any age , but there are some risk factors for its development, in particular: Trauma during childbirth; Multiple, difficult or long births; Use of forceps or other forms of manipulation; Episiotomy with damage to the rectum or anal sphincter muscle. Chronic constipation, straining to defecate and hysterectomy (removal of the uterus) may also contribute to the development of a rectocele. What are the symptoms of a rectocele? A rectocele may be asymptomatic and detected by chance during a routine rectovaginal examination. When a rectocele causes symptoms , they may be of vaginal and/or rectal origin . Vaginal symptoms Vaginal symptoms include: Vaginal bulging (curvature); The feeling of there being a mass inside the vagina; The feeling that there is a large object coming out of the vagina. In rare cases , the following symptoms may also be noted: Vaginal pain or bleeding. In such situations, other possible causes for these symptoms need to be ruled out . Rectal symptoms Rectal symptoms include: Sensation of incomplete evacuation; Constipation; Generalised pelvic pressure; Local discomfort. Some women find that pressing with their finger on the rear wall of the vagina or the area along the periphery of the vaginal canal makes it easier to empty the rectal ampulla. Sometimes, on standing up after evacuation, there is a new and urgent need to defecate . This is due to the movement of accumulated faeces from the rectocele to the lower part of the rectum. How is a rectocele diagnosed? In symptomatic rectoceles , a diagnosis is made on the basis of: Clinical history; Symptoms; Examination of the patient; Any additional examinations that may be considered necessary. In many cases a defecography is recommended , which enables: Assessment of the size and extent of the rectocele; Visualisation of how it empties during defecation; Determination of the treatment approach to be followed. What is the treatment for a rectocele? As a general rule, asymptomatic rectoceles are treated only with dietary changes (increased intake of fibrous foods and liquids), which can help to avoid constipation. Treatment for symptomatic rectoceles also includes measures to improve intestinal transit : Dietary changes - increased intake of fibrous food and liquids; Use of fibre supplements and/or laxatives. Straining to evacuate should be avoided or kept to a minimum . Evacuation can also be helped by exerting pressure with a finger on the rear wall of the vagina or along its periphery, to hold back the rectocele and try to guide the path of the faeces. In some cases it may be necessary to support the pelvic organs with a pessary (an appropriately sized ring that is placed in the vagina). Surgical treatment When medical treatment is not effective, surgery is indicated for the rectocele, with several approaches to resolving it available. The rectocele may be repaired : Via the anus; Via the vagina; Via the perineum (the area between the vagina and the anus); Via the abdomen. In the case of rectoceles involving large prolapses and marked pelvic weakness, several approaches may be used simultaneously . Where a rectocele coexists with other anomalies, it may be better to perform surgery on them all at the same time , which is associated with a higher probability of healing . General surgeons can help to treat this condition. This article was written with the support of physicians and other clinical professionals from the Hospital da Luz network . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
