Overview, Causes, & Risk Factors
Rectocele is a condition in which part of the rectum protrudes or bulges into
the back wall of the vagina.
What is going on in the body?
The rectum lies just behind the vagina in a female. Between the rectum and
vagina is a wall made of tissues and muscles that support the rectum and
vagina. When a woman has a rectocele, the wall supporting the rectum is weaker
than usual. This weakening allows part of the rectum to protrude into the
vagina. As the rectum becomes stretched, it bulges into the vagina. The woman
may experience difficulty passing stool.
What are the causes and risks of the disease?
Rectocele results from a weakening or stretching of the tissues supporting the
rectum. The causes of this weakening include:
muscles and tissues being stretched during childbirth
heavy lifting that causes stress on the muscles surrounding the vagina and
chronic constipation or repeated
straining during bowel movements
excessive coughing, such as from
menopause. Estrogen helps keep
the muscles around the vagina strong. During menopause, estrogen levels
normal aging, which can cause the muscles become weaker
Symptoms & Signs
What are the signs and symptoms of the disease?
Symptoms of a rectocele may include:
bulging of rectal tissue from the vagina
difficulty having a bowel movement
dyspareunia, or pain with sexual
the need for manual evacuation, in which fingers are placed in the vagina
to push the rectum back in order to have a bowel movement
a feeling that the rectum has not been completely emptied after a bowel
leaking of stool from the rectum
low back pain
Diagnosis & Tests
How is the disease diagnosed?
Diagnosis of a rectocele begins with a complete history and physical, including
a pelvic exam and rectal exam. Other tests may include:
ultrasound, which uses sound
waves to show the uterus, bladder, rectum, and cervix
defecography, in which X-rays of the rectum are taken while the person has
a bowel movement
stool culture, in which the stool is examined for bacteria
blood tests, including a complete blood count, or CBC, to check for infection
other X-rays, scans, or tests to rule out other causes of the symptoms
Prevention & Expectations
What can be done to prevent the disease?
This condition may not be preventable. Using caution when doing heavy lifting
may decrease the risk. Careful monitoring, and an episiotomy if necessary, may prevent rectocele during childbirth.
Kegel exercises may strengthen the
wall supporting the vagina and rectum. A pessary may help keep a rectocele from
becoming worse. This is a device that can be put into the vagina to hold the
rectum in place.
Staying active and eating a healthy diet with fiber, fruits, and vegetables may decrease constipation.
What are the long-term effects of the disease?
Long-term effects depend on the severity of the condition. Rectocele may lead
to constipation, hemorrhoids, a hole in part of the intestine, or hard
stool that blocks the intestine. Embarrassment about leaking stool can cause
stress. Other long-term effects will
depend on the success of treatment.
What are the risks to others?
Rectocele is not contagious and poses no risk to others.
Treatment & Monitoring
What are the treatments for the disease?
Treatment of rectocele is aimed at treating and reducing symptoms. These
measures may help:
avoiding straining during bowel movements or heavy lifting
eating a healthy diet, especially one with more fiber
using stool softeners to keep stools soft
doing Kegel exercises to
strengthen the muscles supporting the rectum and vagina
using a pessary, which is a device fitted into the vagina to hold the
rectum in place
using hormone replacement therapy, or
HRT, for postmenopausal women, which
may help to strengthen the muscles around the vagina and rectum
the use of surgery for severe or persistent symptoms, or for a progressive
rectocele. The goal of the surgery is to move the rectum back into its normal
position and hold it there. The muscles of the vagina and rectum can also be
strengthened with surgery.
What are the side effects of the treatments?
Medications used to treat constipation may cause side effects, including nausea,
headache, or diarrhea. Surgery
carries a risk of bleeding, infection, and
allergic reactions to anesthesia.
What happens after treatment for the disease?
Treatments such as activity and diet modifications might be lifelong.
Recovery from surgery may take a few days to several weeks, depending on the
How is the disease monitored?
Any new or worsening symptoms should be reported to the healthcare provider.
Author:Eileen McLaughlin, RN, BSN
Editor:Ballenberg, Sally, BS
Reviewer:Barbara Mallari, RN, BSN, PHN
Harrison's Principles of Internal Medicine, 1998, Fauci et al.