Rectocele

A rectocele (also known as a 'posterior vaginal prolapse') is a type of pelvic organ prolapse. Prolapse means that something has 'fallen out of place'.

Some people have small rectocele without noticing any symptoms. For others, symptoms have a big impact on their quality of life.

Since it affects the rectal and vaginal walls, a rectocele can cause symptoms in both the rectal and vaginal areas.

Rectal symptoms

These can include:

• constipation — difficulty or straining to fully empty your bowels (poo)
• stool (poo) getting stuck in the bulge of your rectum — you may need to press to push it out
• urine (wee) flow is slow or seems to stop and start
• bladder or bowel urgency (feeling that you need to empty your bowels or bladder multiple times a day)
• urinary incontinence
• rectal pain or lower back pain

Vaginal symptoms

These can include:

• a feeling of heaviness, fullness or pressure in your vagina
• feeling that something is 'falling out' of your vagina
• pain during sexual intercourse

If the prolapse is severe, you may be able to see a bulge (the prolapsed rectum) coming out of your vagina.

You might find that your symptoms are worse after long periods of standing.

Rectocele is caused by prolonged pressure on the tissues and muscles that support the pelvic organs (pelvic floor).

It happens when the thin wall of tissue between your vagina and rectum is weakened or damaged. This can occur during pregnancy, vaginal birth or at any time that there is pressure on the muscles around the vagina or rectum.

You are more likely to have a rectocele if you have:

• been pregnant
• given birth
• passed menopause

A rectocele can also be caused by:

• chronic (long-term) constipation
• chronic lung diseases associated with chronic cough
• living with overweight or obesity
• repeated heavy lifting

Sexual activity does not cause or worsen a rectocele.

If you are experiencing any symptoms of a rectocele, you should see your doctor. Early treatment can help reduce the severity of the prolapse.

Your doctor will ask you about your symptoms and how they affect your daily life. Your doctor will also examine you.

Your doctor might refer you for an ultrasound or to a specialist such as a gynaecologist (a doctor who manages conditions that affect the female reproductive system).

Treatment will depend on the severity of the rectocele. It may get worse over time if not treated.

If your symptoms are mild, you may be referred to a physiotherapist or nurse specialising in pelvic floor problems. They can assess you and suggest pelvic floor exercises that might help.

Try to prevent constipation by staying active, drinking plenty of water and eating enough fibre. Avoiding constipation will reduce the pressure in your rectal area.

Your doctor might also recommend a pessary to help decrease urine leakage. This is a plastic device inserted in your vagina to help support your pelvic organs.

If your symptoms can't be managed by pelvic floor exercise and diet, your doctor may recommend surgery to strengthen your vaginal wall.

Transvaginal mesh

Transvaginal mesh implants are no longer approved in Australia due to the high risk of complications. If your doctor thinks you need a transvaginal mesh implant, they need special permission. Make sure you understand the risks and benefits of this surgery.

You can find out more about the problems with transvaginal surgical mesh on the Therapeutic Goods Administration website.

Having a rectocele can impact important aspects of your life including sexual function and your ability to exercise.

If you are struggling with your sexual function, here are some things to try:

• Talk to your partner about your symptoms.
• Take enough time to ensure you are aroused.
• Concentrate on relaxing your inner thighs, buttocks and lower tummy.
• Use a lubricant.
• Use non-latex condoms.
• Use oestrogen pessaries or cream, if recommended by your doctor.

If you have a rectocele or other pelvic organ prolapse, a pelvic floor physiotherapist can guide you in exercising safely and effectively.

Rectocele can lead to medical complications including problems with continence and sexual function.

Lifestyle changes, physiotherapy and medical treatment can usually manage these complications, but sometimes surgery is needed.

If you feel that your vaginal walls are getting weaker you may be able to help prevent a rectocele in these ways:

• Avoid heavy lifting (more than 10kg).
• Maintain a healthy weight — carrying extra weight can make a rectocele worse.
• Have enough fibre in your diet.
• Drink plenty of water.
• Take your time on the toilet and avoid straining.
• Stay active and try pelvic floor exercises.

If you have gone through menopause, your doctor may suggest hormone therapy (oestrogen). In the form of a:

• cream
• pessary
• vaginal tablet

This treatment may help ease some of your symptoms.

Learn more about your pelvic floor from Continence Health Australia.

Visit Birth Trauma Australia for more information about the symptoms, diagnosis and treatment of pelvic organ prolapse.

Call healthdirect on 1800 022 222 at any time to speak to a registered nurse (known as NURSE-ON-CALL in Victoria) for more information and advice.

Do you prefer to read in languages other than English?

HealthTranslations has information about pelvic floor muscle training available in a variety of community languages.

The Royal Women's Hospital Melbourne has a fact sheet on pelvic floor exercises available in a variety of community languages.

Continence Health Australia has fact sheets and videos on topics related to continence available in a variety of community languages.

Looking for information for Aboriginal and/or Torres Strait Islander people?

Continence Health Australia has a range of continence resources for Aboriginal and/or Torres Strait Islander people, including a fact sheet on pelvic floor exercises for women.