A rectocele is a type of pelvic organ prolapse that occurs when the rectum pushes through the back wall of the vagina to form a bulge. They usually occur because there is damage to the tissue and ligaments that sit between the rectum and vagina. This can happen during childbirth although the rectocele may not appear until many years later.

They can also occur when women need to strain to open their bowels. Some women may find that they notice a bulge developing towards the back of their vagina and as it gets bigger it may prevent them from emptying their bowels completely.

The symptoms of a rectocele include

  • Feeling of pressure in the rectum.
  • Feeling the need to go again as the rectum hasn’t completely emptied.
  • A bulge of tissue in the vagina.
  • Difficulty having a bowel movement.
  • Sexual difficulty.

Investigation can involve different types of procedures such as an endoscopy or colonoscopy which puts a flexible camera into the bowel to see if it is a rectocele that is causing the problem.

If the symptoms are mild then it is possible that there will be no need for surgical treatment as avoiding straining will prevent the rectocele from getting any bigger. To help the amount of fruit, vegetables and other fibre should be increased together with drinking plenty of fluids, especially warm water. It may also be necessary to use suppositories to soften bowel movements.

If the rectocele is causing problems then surgery may be recommended. This will almost certainly involve a rectocele repair which involves lifting up the front of the back passage so that the bulge can be repaired with stitches. The lining of the back passage is then trimmed and stitched back to cover the repair. The operation is usually performed under general anaesthetic and takes about 45 minutes.

Some research has suggested that there may be a high incidence of recurrence of a rectocele following trans anal rectocele repair http://www.ncbi.nlm.nih.gov/pubmed/15875294

An alternative treatment is ventral-rectopexy where polypropylene is fastened to the front of the rectum using stitches. The mesh is then fixed using special tacks to the bone at the back of the pelvis known as the sacrum. This has the effect of pulling up the bowel and preventing it from prolapsing downwards. The operation is usually performed laparoscopically through just a couple of keyhole incisions.

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