Rectocele is a form of organ prolapse in which the wall between the rectum and the vagina weakens, which can lead to daily discomfort and bowel problems. This article helps you better understand what a rectocele is, spot the main symptoms and take stock of the ways to ease it: lifestyle adjustments, targeted pelvic floor exercises, rehabilitation with or without a pelvic probe, and surgical options where necessary, always with the support of a healthcare professional.
What is a rectocele?
A rectocele appears following a weakness or strong mechanical strain on the posterior vaginal wall.
More precisely, a rectocele corresponds to a descent of the rectum into the vagina. Not to be confused with a rectal prolapse, which is the rectum coming outside through the anus.
With a rectocele, the hernia is located in the vagina. Depending on the severity of the condition, the rectal hernia may remain intravaginal, but can go as far as sitting 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 slight.
- 2: the rectum reaches the vulvar opening, without coming outside.
- 3: the prolapse extends beyond the vulva.
- 4: the prolapse is fully externalised.
The symptoms of a rectocele
The symptoms of a rectocele can vary with the stage, but certain signs come up frequently:
- A sensation of heaviness, pulling or a "bulge" in the vagina, often more marked at the end of the day or during exertion.
- Difficulty with bowel movements: the impression of not being fully relieved, needing to strain hard or to stay a long time on the toilet.
- Sometimes needing to press with a finger on the vaginal wall or around the anus to help the stool pass.
- Discomfort or diffuse pain in the lower abdomen or pelvic floor, which can worsen when standing for long periods.
- Discomfort during sexual intercourse, sometimes with an unusual sensation of friction or internal pressure.
Can a rectocele be cured?
The pelvic floor is one of the main culprits behind this condition. The pelvic organs are held in place by a double system:
- a ligament system that suspends these organs;
- the pelvic floor that supports them.
Unfortunately, with a prolapse, both systems are failing and there is no way to "re-tighten" the suspensory ligaments.
On the other hand, it can be extremely beneficial to strengthen the pelvic floor in order to give good support to the pelvic organs (of which the rectum is one).
Besides pelvic floor rehabilitation, the other causes also need addressing. Many factors influence pelvic floor tone and can contribute to weakening the pelvic muscles.
I take care of my pelvic floor
What are the causes of a rectocele?
Constipation
Chronic constipation can be an identified cause of rectocele. If you are prone to constipation, the repeated straining you do can weaken your pelvic floor. This can cause an evacuation disorder when you need to go to the toilet.
Furthermore, when you strain to pass stools, you also need to relax the sphincter. If that does not happen, you will have to redouble your effort to expel the stool. As a result, you place more demand on your pelvic floor and, through repeated straining, you may develop a rectocele.
One or more deliveries
Vaginal delivery is a frequent cause of rectocele. A traumatic tearing of the ligament attachments of the pelvic organs caused by childbirth can bring on a rectocele.
But it can appear long after a delivery, especially if pelvic floor rehabilitation was not done, or was simply insufficient.
A hormonal change
At menopause, a woman's body undergoes many changes. Among them, the gradual decline in hormones is the hardest to manage.
It can indeed weaken the pelvic floor muscles. This weakening can bring on a prolapse.
Rectocele: when to consult and which examinations?
Rectocele can be treated, but it should not be taken lightly. Choosing the treatment best suited to the prolapse takes several elements into account:
- the symptoms present;
- age;
- the patient's general state of health;
- the grade of the prolapse; and so on.
Rectocele: possible treatments without surgery
If it is detected early, a few pelvic floor rehabilitation sessions may ease the symptoms of the rectocele and avoid surgery. There are, in particular, exercises suited to easing a rectocele.
Pelvic floor rehabilitation as first-line treatment
If you have a rectocele, sessions of pelvic floor rehabilitation using biofeedback will be prescribed with a healthcare professional.
Biofeedback therapy is one of the most effective methods for improving a rectocele from the first symptoms. Targeted rehabilitation of the anus makes it possible to regain normal sensations on the toilet.
Pelvic floor rehabilitation also makes it possible to avoid surgery and/or to ease post-operative recovery if surgery is necessary. The sessions with the healthcare professional can be followed by pelvic floor exercises to do at home.
Pelvic floor exercises with the Emy solution
Practising regular exercises will make it possible to maintain the benefits of the sessions done in a clinic and to limit the worsening of your rectocele over the long term.
The Emy solution makes it possible to do exercises suited to easing urinary symptoms. This medical device offers a pelvic floor probe that connects to a mobile app. The app offers playful and varied medical games, accessible from your smartphone.
It is an effective way to do exercises at home and stay motivated.
Taking laxatives for constipation
For patients with bowel problems, a treatment based on laxatives may be proposed.
The aim is to soften the stools in order to remove the symptoms caused by the rectocele. If symptoms persist, surgery may then be proposed.
When to consider surgery for a rectocele?
Pelvic floor rehabilitation and/or laxative treatments are sometimes not enough to treat a rectocele. 10 to 20 % of genital prolapses are managed surgically.
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 be able to assess whether abdominal, vaginal or anal surgery is the most suitable.
This operation is carried out by laparoscopy, opening the posterior wall of the vagina, the perineum or the anterior wall of the rectum. Some surgeons bring the levator muscles or the rectal wall back together anatomically.
Other surgeons prefer thin mesh placed between the vagina and the rectum. A final technique involves a resection. The part of the rectum that "falls" is removed, then the surgeon sutures the rectal wall.
Who to consult for a rectocele?
If you have the slightest doubt about the appearance of a prolapse of any kind, book an appointment with your gynaecologist or your GP. They can recommend a suitable treatment or refer you to a urologist, a gastroenterologist or a proctologist for more in-depth examinations.
How to live with a rectocele?
According to the French health authority, 30 to 50 % of women experience an organ prolapse — you are not alone! The subject is still very taboo, but natural solutions do exist.
Strengthening your pelvic floor regularly
Many women live normally with a rectocele thanks to regular pelvic floor rehabilitation exercises and/or taking a laxative treatment.
The testimonial of Ghislaine, who has a rectocele caused by chronic post-operative constipation, is a good example (testimonial originally collected in French). Doing exercises regularly with the Emy probe helped her tackle her rectocele problem.
Find out more about the Emy probe
Adapting your daily activities
It is also entirely possible to have sexual relations with your partner if you have an organ prolapse. That said, you may experience a disturbance in your libido or a decrease in your orgasms.
But do not worry, there are ways to remedy this. Because yes, you can absolutely flourish sexually with a rectocele!
Monitoring how your rectocele symptoms develop
If you live with a rectocele, you need to stay vigilant and attentive to the appearance of new symptoms such as:
- Constipation or difficulty passing stools properly.
- Anal incontinence.
- Pain or bleeding at the rectum.
- A sensation of heaviness in the lower abdomen, worsened during bowel movements or exertion.
- Pain during sexual intercourse.
The appearance of one or more symptoms could signal a worsening of the condition. It should be reported to your doctor promptly.
Talking with others living with a rectocele
To live calmly with a rectocele, consider joining an online forum. By talking with other women affected by this condition, you will find comfort and valuable advice. There is nothing like a space for exchange to share tips and manage this condition day to day!
Many women live with a rectocele every day — you are not alone! So do not hesitate to get help from a healthcare professional to find the solution that suits you best for living with your rectocele.
Sources
- Prolapsus génital de la femme : prise en charge thérapeutique, Haute Autorité de Santé (HAS), Mai 2021, Recommandation de bonne pratique – link
- Prospective evaluation of the connected biofeedback EMY Kegel trainer in the management of stress urinary incontinence, Jochum F et al., February 2022, Journal of Gynecology Obstetrics and Human Reproduction 51(2):102280 – link
