Consumer Information

Rectocele

GENERAL INFORMATION:

What is a rectocele? A rectocele (REK-to-sel) is also called a vaginal hernia. This is a bulge of the front wall of the rectum into the vagina. The rectum is the last part of the large bowel (colon) where stool is stored for a short time. In women, the rectum is just behind the vagina. A wall of tough, fiber-like tissue, called the rectovaginal septum, separates the rectum from the vagina. The rectovaginal septum may be weak and thin. This weakening allows part of the rectum to push into the vagina.

What causes a rectocele? A rectocele is often caused by weak muscles and ligaments that hold and support the vagina and rectum. This may be due to the following:

Aging: Aging can cause the muscles to become weak. After menopause, a woman's body makes much less estrogen. Less estrogen makes pelvic muscles weaker.
Childbirth: Pregnancy, and trauma during labor and delivery of a baby, may cause weak muscles around the vagina or rectum. This may be from the use of forceps in helping the delivery, or tears into the rectum during delivery. Having a large baby or multiple pregnancies may increase the risk.
Genetics: Some women are born with weaker muscles in their rectum and vagina. They are more likely to have rectoceles.
Obesity: Weighing more than what is suggested by your caregiver may increase your risk of having a rectocele.
Straining: The pressure inside the rectum increases when you strain. This usually happens with constipation (dry, hard stools that are difficult to pass), forceful coughing, and lifting heavy objects.
Surgery: Past pelvic surgeries, such as a hysterectomy (removal of the womb), may weaken the muscles around your vagina.

What are the signs and symptoms of a rectocele? You may not have any signs or symptoms. If you have signs or symptoms, these may include one or more of the following:

A soft bulge of tissue in your vagina that may poke out through the vaginal opening.
Constipation.
Stool that leaks out from your rectum.
Low back pain that goes away when you lie down.
Pain or pressure in your vagina when passing urine or having sex.
Pressure in your rectum, or feeling that your rectum is not empty after having a bowel movement (BM).

How is a rectocele diagnosed? Your caregiver will ask you about your lifestyle, past pregnancies, and any diseases you may have had. You may need one or more of the following tests:

Bimanual examination: During this exam, feel free to ask for a woman to be present if one is not. Your caregiver gently puts a warmed tool (speculum) into your vagina. A speculum is a tool that opens your vagina. Then he will ask you to strain or push down. This may cause a rectocele to bulge so he can check its size and location. You may need to tighten the muscles of your pelvis as if you are trying to stop urinating. This helps your caregiver learn how strong your pelvic muscles are.
Defecography: For this test, a thick paste of barium is placed into your rectum through your anus. X-rays are taken while you push out the barium as if you are having a BM. The barium makes an x-ray outline of your rectum and anus. This shows the changes taking place in your rectum and muscles during a BM.
Magnetic resonance imaging test: This test is also called an MRI. The MRI makes computerized pictures of your abdomen or pelvis (hips). Caregivers use these pictures to look for problems in your rectum, vagina, bladder, or other pelvic organs. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.
Pelvic floor fluoroscopy: This is a special type of x-ray that shows the movement of your bowels, vagina, bladder, or rectum. Pictures of these body parts are taken and shown on a video screen. Caregivers may give you dye to help your body parts show up better on the screen.
Ultrasound: Sound waves are used to show pictures of the inside of your abdomen. A small wand with lotion on it is gently moved around your abdomen. The wand may also be placed in your vagina. Pictures of your rectum, vagina, bladder, or other pelvic organs are seen on a TV-like screen.
Other tests:
- Anorectal manometry: A flexible tube is inserted through your anus and into your rectum. Pressure from the muscles around your anus and rectum is measured by sensors in the tube.
- Barium enema: A barium enema is an x-ray of the colon. A tube is put into your anus, and a liquid called barium is put through the tube. Barium is used so that caregivers can see your colon better on the x-ray film.
- Colonic transit studies: This test measures how fast things pass through your colon. You will be asked to swallow a large pill containing tiny plastic rings that serve as markers. These markers can be seen on x-rays. Pictures of your abdomen are taken for several days and the markers are counted. This helps your caregiver learn how long it takes for food to pass through your intestines.
- Colonoscopy: A colonoscopy is a test that is done to look at your colon. A tube with a light on the end will be put into your anus, and then moved forward into your colon.

How is a rectocele treated? If you have no signs or symptoms, you may not need any treatment for your rectocele. Caregivers may tell you to eat a high fiber diet and drink plenty of liquids. You may also need one or more of the following:

Biofeedback therapy: Biofeedback uses special equipment to train you how to control and relax your pelvic muscles, especially during a BM. Ask your caregiver for more information about biofeedback.
Estrogen therapy: If you are in menopause, your caregiver may suggest that you take estrogen hormones. This medicine may be taken as a pill, or it may be a cream which is placed in your vagina. Estrogen helps keep your pelvic muscles strong and may prevent your rectocele from getting worse.
Pessary: A pessary is a plastic or rubber ring that is placed inside your vagina. This supports the bulging areas in your vagina and rectum.
Surgery: For some cases of rectocele, surgery may be needed to move the rectum back into place. The muscles and ligaments around your vagina may be sutured (tied up) to make them strong. A mesh patch may also be used to add support to the rectovaginal septum.

How can a rectocele be prevented?

Avoid pressure in your abdomen: Do not strain or lift heavy objects.
Do Kegel exercises regularly: This exercise squeezes your pelvic floor muscles and helps them get stronger. Ask your caregiver for more information about Kegel exercises.
Drink 8 to 10 (eight-ounce) cups of liquids each day: Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Good drink choices for most people include water, juice, and milk. If you drink liquids that contain caffeine, such as coffee, these can also be counted in your daily liquid amount. Some food items such as soup and fruit also add liquid to your diet. Try to drink enough liquid each day, and not just when you feel thirsty.
Eat more fiber: High fiber foods, such as fresh fruits, vegetables, and whole grains, soften stools. This helps stools pass more quickly through your colon. Slowly add fiber into your diet to avoid bloating, stomach pain, and gas.
Maintain a healthy weight: Talk to your caregiver about the best weight for you. Ask for help planning an exercise program. Exercise helps your bowels work better and decreases pressure inside your colon. Exercise for at least 30 minutes every day.
Treat your cough: If you have a chronic (long-term) cough, tell your caregiver. Get help to stop smoking. Many people who smoke get a chronic cough over time. Ask your caregiver for more information about how to quit smoking if you are having trouble quitting.

Where can I find more information? Accepting that you have a rectocele may be hard. You and those around you may feel scared, confused, and anxious. These feelings are normal. Talk to your caregiver, family, or friends about your feelings. Contact the following for more information:

National Digestive Diseases Information Clearinghouse (NDDIC)
2 Information Way
Bethesda, MD 20892-3570
Phone: 1-800-8915389
Web Address: www.digestive.niddk.nih.gov

The American College of Obstetricians and Gynecologists
409 12th Street, SW
Washington, DC 20090
Phone: 1-202-638-5577
Web Address: http://www.acog.org

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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