What Is A Rectocele? What Causes A Rectocele?
A rectocele, also called a proctocele, results from a tear in the normally tough, fibrous, sheet-like divider between the rectum and vagina (rectovaginal septum), causing a bulge to protrude as a hernia into the vagina when there is a bowel movement. It is mainly caused by childbirth or a hysterectomy. It is more likely to occur as a result of childbirth if the baby weighs over nine pounds, or the birth was fast.
If the rectocele is small the patient may not notice it, there may be no signs or symptoms at all. In larger cases there may be a perceptible protrusion of tissue through the vaginal opening. The woman may experience some discomfort - pain is rare.
According to Medilexicon's medical dictionary a rectocele is:
"Prolapse or herniation of the rectum."
In the majority of cases the patient can treat the rectocele with self-care and other non-surgical methods. Surgery may be required in severe cases.
Males may also develop a rectocele (extremely rare).
What are the signs and symptoms of a rectocele?A symptom is something the patient senses and describes, while a sign is something other people,
In mild cases the woman may sense pressure within the vagina, she may feel that her bowels have not been completely emptied after going to the toilet.
In moderate cases an attempt to evacuate can push the stool into the rectocele rather that out through the anus, there may be pain and discomfort during evacuation. There is a higher chance of having constipation. Some women may experience pain during sexual intercourse.
Some women say it feels as if "something is falling out/down" within the pelvis.
In severe cases there may be vaginal bleeding, occasional fecal incontinence, and sometimes the prolapse of the bulge through the mouth of the vagina, or rectal prolapse through the anus.
Many females have rectoceles, but only a few may feel any symptoms.
What can cause a rectocele?Roctoceles can have several causes, the most common being childbirth, especially when the baby is big (over nine pounds). Rapid births are also common causes. Experts say that using forceps during delivery is more likely to cause vaginal injury than directly cause the tear that leads to a rectocele.
The more vaginal births a woman has had, the higher her risk. However, females who have never given birth can also develop a rectocele.
The following may also cause rectoceles:
- A drop in estrogen levels when a woman gets older (menopause) can make pelvic tissues less elastic, increasing the risk of developing a rectocele
- A hysterectomy
- Chronic constipation
- Lots of long-term coughing, as in chronic bronchitis
- Pelvic surgery
- Sexual abuse during childhood (often an overlooked cause)
- Obesity or overweight
Females who only have cesarean births have a significantly lower chance of developing rectoceles compared to those who give birth naturally.
How is a rectocele diagnosed?Doctors can usually diagnose a rectocele after examining the vagina and rectum. However, determining how big it is can sometimes be difficult. The patient may have to answer a questionnaire which helps the physician assess the degree of prolapse and whether it is having any impact on the her quality of life.
Imaging tests are not usually needed for an accurate diagnosis. However, the doctor may detect something during the physical examination that requires identification. In such cases an MRI (magnetic resonance imaging) scan or an X-ray may be ordered. Imaging tests can also show how big the rectocele is and how well the patient is emptying her rectum. A defecagram (defecrography) is a type of X-ray study that helps the doctor determine the size of the rectoceles and how well the patient is evacuating.
What are the treatment options for a rectocele?In mild cases no medical treatment, apart from some pelvic exercises (Kegel exercises), is required. The patient should consume plenty of fluids and eat fiber to avoid constipation. It is important that she avoids prolonged straining when going to the toilet.
A woman with a rectoceles should avoid any type of heavy lifting and/or prolonged coughing.
If the patient is overweight or obese the doctor will advise her to try to lose weight.
The doctor may prescribe stool softeners. Hormone replacement therapy (HRT) may be recommended for post-menopausal women.
A vaginal pessary (plastic/rubber ring inserted into the vagina) helps support the protruding tissues.
Surgery, if necessary, is directed at repairs to the rectovaginal septum, which involves a simple incision (placation) of the vaginal skin.
PreventionDon't smoke. Smoking increases the risk of having a chronic cough.
Do your Kegel exercises regularly, especially after you have given birth.
Try to maintain a healthy body weight.
If you have a chronic cough, get it treated.
Avoid constipation and prolonged straining when going to the toilet.