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WHAT YOU NEED TO KNOW:
What is a rectocele?
A rectocele, or vaginal hernia, is a bulge of the front wall of your rectum into your vagina.
What causes a rectocele?
A rectocele is often caused by weak muscles and ligaments that cannot hold and support the vagina and rectum. A wall of tough 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. Weakening may be caused by 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 muscles around the vagina or rectum to weaken. Forceps used in the delivery, or tears into the rectum during delivery may cause the muscles to weaken. Large babies or multiple pregnancies may make your muscles weaker.
- Genetics: You may have been born with weaker muscles in your rectum and vagina.
- Obesity: More weight than what is suggested by your healthcare provider can put extra pressure on your muscles.
- Straining: The pressure inside your rectum increases when you strain. This usually happens with constipation, forceful coughing, and lifting heavy objects.
- Surgery: Past pelvic surgeries, such as a hysterectomy, may weaken the muscles around your vagina.
What are the signs and symptoms of a rectocele?
- A soft bulge of tissue in your vagina that may poke out through the vaginal opening
- Bowel movement that leaks out from your rectum
- Low back pain that goes away when you lie down
- Pain or pressure in your vagina when you urinate or have sex
- Pressure in your rectum, or you feel that your rectum is not empty after you have a bowel movement
How is a rectocele diagnosed?
Your healthcare provider will ask you about your lifestyle, past pregnancies, and any diseases you may have had. You may also need any of the following tests:
- Manual exam: Your healthcare provider gently puts a warmed 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 healthcare provider learn the strength of your pelvic muscles.
- Defecography: 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 bowel movement. 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 bowel movement.
- MRI: This scan uses powerful magnets and a computer to take pictures of your abdomen and pelvis. The pictures may show problems in you rectum, vagina, or bladder. You may be given dye to help the pictures show up better. Tell the healthcare provider if you have ever had an allergic reaction to contrast dye. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.
- Pelvic floor fluoroscopy: This is an x-ray that shows the movement of your bowels, vagina, bladder, or rectum. Pictures of these body parts are taken and shown on a monitor. Healthcare providers may give you dye to help the pictures show up better on the screen. Tell the healthcare provider if you have ever had an allergic reaction to contrast dye.
- Ultrasound: This test uses sound waves to show pictures on a monitor. An ultrasound may be done to show problems with your rectum, vagina, or bladder.
- 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.
- 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 healthcare provider learn how long it takes for food to pass through your intestines.
How is a rectocele treated?
- Biofeedback therapy: Biofeedback uses equipment to train you to control and relax your pelvic muscles during a bowel movement. Ask your healthcare provider for more information about biofeedback.
- Estrogen: Estrogen is a hormone that may be taken as a pill, or applied as a vaginal cream. 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: Surgery may be needed to move the rectum back into place. This surgery fixes the weak walls of your vagina. Your rectum will move back into place once the walls of your vagina are fixed.
What are the risks of a rectocele?
A pessary may cause pain or infection. You may develop irregular bleeding or cancer if you use estrogen. Your rectocele may happen again, even with treatment. Your intestines may become blocked without treatment.
How can I help prevent a rectocele?
- Avoid pressure in your abdomen: Do not strain when you have a bowel movement. Do not lift heavy objects. Tell your healthcare provider if you have a severe cough.
- Do Kegel exercises regularly: Squeeze your pelvic floor muscles to help them get stronger. Ask your healthcare provider for more information about Kegel exercises.
- Drink liquids as directed: Ask your healthcare provider how much liquid to drink each day and which liquids are best for you. Liquids will help decrease constipation.
- Eat more fiber: High-fiber foods, such as fresh fruits, vegetables, and whole grains, soften bowel movements. This helps bowel movements pass more quickly through your colon. Slowly add fiber into your diet to avoid bloating, stomach pain, and gas.
- Maintain a healthy weight: Ask your healthcare provider how much you should weigh. Ask him to help you create a weight loss plan if you are overweight. Ask for help planning an exercise program. Exercise helps your bowels work better and decreases pressure inside your colon.
When should I contact my healthcare provider?
- Your pain does not go away, even with treatment.
- Your pessary falls out.
- You have heavier vaginal bleeding than usual.
- You are unable to have a bowel movement.
- You have questions or concerns about your condition or care.
When should I seek immediate care or call 911?
- You have a mass hanging out of your vagina that you cannot push back into place.
- You vomit several times in a row.
- Your bowel movement is bright red or black.
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