A rectocele is a type of organ prolapse where the wall between the rectum and vagina weakens, which can cause daily discomfort and bowel movement issues. This article helps you better understand what a rectocele is, identify the main symptoms, and review the solutions to relieve it: lifestyle adjustments, targeted pelvic floor training, pelvic floor recovery with or without a pelvic floor trainer, and surgical options when necessary, always with the support of a healthcare professional.
What is a rectocele?
A rectocele occurs due to a weakness or strong mechanical stress applied to the posterior vaginal wall.
More precisely, a rectocele is a descent of the rectum into the vagina. It should not be confused with a rectal prolapse, which is when the rectum protrudes through the anus.
In the case of a rectocele, the hernia is located inside the vagina. Depending on the severity of the condition, the rectal hernia can remain within the vagina, but it can also extend outside the vulva.
Rectocele: Common Symptoms and Stages
The Different Grades
This condition is classified into the following 4 grades:
- 1: The prolapse is intravaginal and the rectal descent is mild.
- 2: The rectum reaches the vulvar opening without protruding.
- 3: The prolapse extends beyond the vulva.
- 4: The prolapse fully protrudes.
Symptoms of a Rectocele
Symptoms of a rectocele can vary depending on the stage, but some signs are common:
- A feeling of heaviness, pulling, or a "lump" in the vagina, often more noticeable at the end of the day or during physical exertion.
- Difficulty with bowel movements: feeling not fully relieved, needing to push hard or spend a long time on the toilet.
- Sometimes needing to press on the vaginal wall or around the anus with a finger to help stool evacuation.
- Discomfort or diffuse pain in the lower abdomen or pelvic floor, which may worsen when standing for long periods.
- Discomfort during sexual intercourse, sometimes with an unusual rubbing sensation or internal pressure
Can a Rectocele be Healed?
The pelvic floor is one of the main contributors to this condition. The pelvic organs are held in place by a dual system:
- a ligament system that suspends these organs;
- the pelvic floor which supports them.
Unfortunately, during a prolapse, these two systems fail, and there are no solutions to "tighten" the suspensory ligaments.
However, it can be extremely beneficial to strengthen the pelvic floor to provide quality support to the pelvic organs (including the rectum).
Alongside pelvic floor training, it’s important to address other causes. Many factors affect pelvic floor tone and can contribute to weakening the pelvic muscles.
I take care of my pelvic floor
What Causes a Rectocele?
Constipation
Chronic constipation can be a recognized cause of rectocele. Indeed, if you suffer from constipation, the repeated straining can weaken your pelvic floor. This may cause evacuation difficulties when you need to have a bowel movement.
Furthermore, when you strain to pass stool, you also need to relax your sphincter. If this doesn’t happen, you’ll have to push even harder to expel your stool. As a result, your pelvic floor is put under greater strain, and with repeated straining, you may develop a rectocele.
One or More Childbirths
Vaginal delivery is a common cause of rectocele. Traumatic rupture of the ligament attachments of the pelvic organs caused by childbirth can lead to a rectocele.
But this can appear long after after childbirth, especially if postpartum pelvic floor recovery was not done or was simply insufficient.
A hormonal change
At the time of menopause, women’s bodies undergo many changes. Among these, the gradual decline in hormones is the most challenging to manage.
Indeed, this decline can weaken the pelvic floor muscles. This weakening can lead to a prolapse.
Rectocele: when to consult and what exams are needed?
Rectocele can be treated, but it should not be taken lightly. Choosing the most appropriate treatment for prolapse involves several factors :
- the symptoms present ;
- age ;
- the patient’s overall health status ;
- the grade of the prolapse ; etc.
Rectocele: possible treatments without surgery
If detected early, a few pelvic floor training sessions can relieve rectocele symptoms and help avoid surgery. There are also specific exercises to relieve rectocele.
Pelvic floor training as first-line treatment
If you have a rectocele, pelvic floor training with biofeedback sessions will be prescribed by a healthcare professional.
Biofeedback therapy is one of the most effective methods to improve rectocele from the first symptoms. Targeted training of the anus helps restore the sensation of bowel movements.
Pelvic floor training also helps avoid surgery and/or facilitate post-operative recovery if surgery is necessary. Training sessions with your healthcare professional can be followed by pelvic floor exercises to do at home.
Exercises for rectocele with the Emy solution
Regular exercise practice helps maintain the benefits of in-clinic sessions and limit the worsening of your rectocele over the long term.
Learn more about my pelvic floor
The Emy solution offers exercises adapted for rectocele. This medical device includes a pelvic floor trainer that connects to a mobile app. The app provides engaging and varied medical games, accessible from your smartphone.
This is an effective solution for doing exercises at home and staying motivated if you suffer from a rectocele.
Using laxatives to relieve constipation
For patients experiencing bowel transit issues, a treatment based on laxatives may be recommended.
The goal is to soften the stools to eliminate the symptoms caused by the rectocele. If symptoms persist, then surgical intervention may be proposed.
When to consider surgery for a rectocele?
Pelvic floor training and/or laxative treatments are sometimes not enough to treat a rectocele. 10 to 20% of genital prolapses require surgical management.
The aim of surgical treatment is to restore anal function by correcting the anatomy of the wall between the vagina and the rectum.
Only a healthcare professional can advise you on this. They will assess whether abdominal, vaginal, or anal surgery is the most suitable.
Mesh placement is performed via laparoscopy by opening the posterior vaginal wall, the pelvic floor, or the anterior rectal wall. Some surgeons opt for anatomical reconstruction of the levator muscles or the rectal wall.
Other surgeons prefer thin prostheses placed between the vagina and rectum. A final technique involves removal: the part of the rectum that "drops" into the uterus is removed, and the surgeon then sutures the rectal wall.
Who should you see for a rectocele?
If you have any doubts about the appearance of a prolapse of any kind, make an appointment with your gynecologist or your general practitioner. They can recommend an appropriate treatment or refer you to a urologist, a gastroenterologist, or a proctologist for further examinations.
To learn more about prolapse management, we invite you to watch this video on the subject, created by a physiotherapist and a gynecologist.
How to live with a rectocele?
According to the High Authority of Health, 30 to 50% of women experience pelvic organ prolapse—you are not alone! This topic remains very taboo, but natural solutions do exist.
Strengthen your pelvic floor regularly
Many women live normally with a rectocele thanks to regular pelvic floor training exercises and/or laxative treatments.
The testimony of Ghislaine, who suffers from a rectocele caused by chronic post-operative constipation, is a good example. Doing regular Exercises with the Emy pelvic floor trainer helped her resolve her rectocele issue.
Learn more about the Emy pelvic floor trainer
Adjusting your daily activities
It is absolutely possible to have sexual relations with your partner if you have a pelvic organ prolapse. However, you might experience a libido issue or a reduction in your orgasms.
But don’t worry, there are solutions to help. Yes, you can absolutely enjoy a fulfilling sex life with a rectocele!
Monitoring the progression of your rectocele symptoms
If you live with a rectocele, you need to stay vigilant and attentive to the appearance of new symptoms such as:
- Constipation or difficulty fully evacuating stools.
- Anal incontinence.
- Pain or bleeding in the rectal area.
- A feeling of heaviness in the lower abdomen that worsens during bowel movements or physical exertion.
- Pain during sexual intercourse.
The appearance of one or more of these symptoms could indicate a worsening of the condition. It’s important to report this promptly to your doctor.
Connecting with others living with a rectocele
To live peacefully with a rectocele, consider joining an online forum. Talking with other women affected by this condition will provide you with comfort and valuable advice. There’s nothing like a community platform to share tips and manage this condition day-to-day!
By searching "rectocele forum" on your preferred search engine, you can easily find suitable platforms and connect with their members.
Many women live with a rectocele daily, you are not alone! So don’t hesitate to seek support from a healthcare professional to find the best solution for you to live well with your rectocele.
FAQ – Rectocele
What are the early symptoms of a rectocele and how can you recognize them in women?
The initial signs are often gradual and mainly characterized by pelvic discomfort and difficulties with bowel movements. The most common symptoms include:
- A feeling of vaginal bulging or low pressure inside the vagina, especially when standing or after exertion;
- Difficulty fully evacuating stools (feeling of incomplete bowel emptying), needing to push hard or use finger assistance;
- Chronic constipation or blocked stools, sometimes requiring laxatives;
- Mild fecal leakage or anal incontinence if pelvic support is severely compromised;
- Discomfort during sexual intercourse (dyspareunia);
- A noticeable or palpable protrusion against the vaginal wall; some cases may remain minimally symptomatic and only detected during a routine gynecological exam.
How can you differentiate a rectocele from a prolapse of another pelvic organ (cystocele, vaginal vault prolapse, uterus)?
Differentiation is based on a gynecological examination:
- A cystocele: bulging of the anterior vaginal wall related to the bladder;
- A rectocele: bulging of the posterior vaginal wall related to the rectum;
- A uterine prolapse: descent of the uterus/cervix towards the vaginal opening.
The POP-Q scoring system, observation while standing, and patient’s bearing down help specify the affected wall. Dynamic imaging (defecography or dynamic MRI) is useful when multiple compartments are involved.
What are the most common causes of rectocele formation?
The causes reflect a weakening of the pelvic support structures:
- Repeated or difficult vaginal deliveries;
- Chronic straining, constipation;
- Age and menopause (hormonal changes and looser connective tissue);
- History of pelvic surgery, perineal injuries, obesity, chronic cough, repeated heavy lifting.
The combination of these factors leads to relaxation of the rectovaginal septum and visible bulging.
What does a complete pelvic assessment involve to confirm a rectocele?
The assessment includes several steps:
- Medical history: symptoms, obstetric and surgical history, bowel habits.
- Clinical examination: inspection while standing and gynecological exam, vaginal and rectal palpation, Valsalva maneuvers, POP-Q scoring.
- Functional tests: sphincter tone, anorectal examination if incontinence is present.
- Dynamic imaging: defecography or dynamic MRI, endovaginal ultrasound or pelvic MRI to determine the size of the rectocele and assess the associated mechanisms.
The clinical–radiological correlation is essential to guide the therapeutic choice.
What is the recurrence rate after surgical repair of a rectocele?
The rate varies depending on the technique:
- Transvaginal repair: anatomical recurrence ~5–13%;
- STARR technique (transanal): recurrence ~6–13% at 18–42 months, with some older series reporting up to 30–40%.
The definition of recurrence (symptoms vs imaging), follow-up, and combination with other pelvic procedures influence these figures. Patients should be informed about the risk of both functional and anatomical recurrence.
What factors worsen a rectocele?
- Chronic constipation and repeated straining during bowel movements;
- Multiple or traumatic childbirths;
- Obesity, chronic cough, heavy lifting;
- Menopause and hormonal factors;
- Poor ano-rectal coordination or transit disorders;
- Lack of early management.
Addressing modifiable factors (pelvic floor training, bowel transit regulation, weight loss) helps limit progression.
What functional outcomes can be expected after surgical correction of a rectocele?
Surgical goals:
- Improvement in bowel movements and relief from the sensation of incomplete evacuation;
- Reduction of vaginal discomfort and obstructive symptoms (50–60% improvement reported in some STARR series);
- Variability in results depending on coexisting ano-rectal functional disorders;
- Possible side effects: pain, dyspareunia, temporary urinary issues; long-term recurrence risk for a minority.
Surgery should be combined with appropriate medical-functional management and a carefully considered decision by a specialist.
Source
Recommendations from the French National Authority for Health – Female Genital Prolapse: Therapeutic Management.
