Introduction : What is Rectocele?

Rectocele happens when the supportive tissues between the vagina and rectum weakens and  that causes the front of the rectum to bulge into the back wall of the vagina. The other articles in this series were Vaginal prolapse, Cystocele and Uterine Prolapse .

Rectocele is not the same as Rectal prolapse.In rectal prolapse, the rectum bulges through the rectum and not through the vaginal wall.

Women are more likely to have a rectocele than men. A small % of men can develop Recocele following the removal of prostate, as a  treatment for  prostate cancer.Rectocele  is usually seen in older women, after multiple vaginal births.

When it’s a small rectocele people do not have symptoms and it does not need any treatment. Certain lifestyle modifications can help maintain and slow down the progression of the rectocele.See the table of do’s and don’ts to manage pelvic organ prolapse at the end of this article. Rectoceles need treatment only when they start to interfere with the quality of life, and lifestyle.

Definition: It is the bulging of the rectum into  the posterior (back wall ) of the vagina.

Causes :

• Traumatic Vaginal Delivery : The tears/ episiotomy ( surgical incision ) that can occur can reach to the rectum.
• Weak pelvic floor muscles and weakening of the tissues b/w the rectum and the vagina. 
• History of constipation involving chronic straining.
• Rectal surgeries 
• Pelvic surgeries( Hysterectomy )

Symptoms : Can be divided into Rectal and Vaginal Symptoms

Rectal Symptoms	Vaginal symptoms
Rectal Pain	Painful Intercourse (dyspareunia)
Difficulty emptying the bladder , and feeling of  “stool getting stuck”.	Feeling of vaginal fullness
Feeling the need to splint (using the finger)  through the vagina to evacuate the bowel.
Constipation.
Urge to defecate frequently

Diagnosis :

Rectocele  can be detected in a physical pelvic exam by a gynecologist, colorectal surgeon , or urogynecologist .Further tests may also be done to assess the severity more accurately.

Tests :

Defecography :Special  X-ray that shows the changes in rectum and anal canal during defecation. This test can be very specific about the degree of prolapse and the extent of bowel emptying.

Treatment :

Treatment can be both surgical and non surgical treatment depending on the severity of the Rectocele.

• Non Surgical Treatments :Mild cases can be treated without any surgical methods with remedies like bowel retraining.
• Surgical Treatments : Surgical options considered when non surgical treatments do not resolve the symptoms and continue to interfere with the quality of life.Surgery aims to strengthen the wall between the vagina and the rectum to fix the rectocele. Posterior Colporrhaphy is the surgical way to fix rectocele.

Physical Therapy :

Pelvic floor exercises are an effective way to strengthen the Pelvic floor muscles and to help maintain and prevent further worsening of rectocele.

When a pelvic organ prolapse is noted depending on the degree of prolapse it can be managed at home with the below listed Do’s and Don’t .For effectiveness regular, consistent practice is required .

Do’s	Don’ts
Bowel Movements: Do avoid constipation. Do eat a well balanced diet by increasing your fiber intake  and develop regular bowel habits .	Don’t  strain to have a bowel movement.
Sitting on the toilet : Do sit correctly on the toilet. When having a bowel movement do  sit on the toilet with the knees higher than the hips which can be achieved by placing your feet on a stool.Lean forward from your hips and keep your spine straight.With Diaphragmatic breathing (I have  an article  in my previous post on the blog) relax the Pelvic floor muscles to have an easy bowel movement.	Don’t hover over the toilet to urinate. Don’t try to push out or force urine out  Don’t not bear down to evacuate the bowels , just once instance of bearing down can also worsen the prolapse if you already have it. Don’t hold your breath as you are bearing down.This is called the Valsalva breathing .
Lifting :Do breath out when doing the lifting.
Pelvic Floor Exercises: Do definitely do your pelvic floor exercises. Do practice “ the knack”( Out lined in my previous blog post titled how to avoid urinary Incontinence)	Don’t engage in high impact exercises and exercises that require heavy repetitive lifting such as crossfit workout.
Treat Chronic Cough:Do treat the cause of Chronic cough, it will help avoid repeated increase of intra abdominal pressure that in turn puts pressure on the pelvic floor muscles.

Conclusion

• Rectocele is when rectum budges thought the posterior wall of the vagina.

• This can be treated successfully non surgically in mild case of prolapse.

• Pelvic Physical Therapy can be an effective way to manage mild degrees of prolapse.

• Any question or comments are welcome .