Rectocele refers to a bulge (prolapse) of the front wall of rectum into the back wall of vagina. This occurs when there is weakening of the wall between the rectum and vagina (the rectovaginal septum) and the pelvic floor. Weakness may be secondary to birthing trauma during previous vaginal delivery, history of constipation and straining, previous surgery (e.g. hysterectomy or rectal surgery), or aging. Pelvic floor is a group of muscles and connective tissues that work together to support the organs in the pelvis including the anus and rectum, bladder, uterus and vagina. As the pelvic support weakens, the normal angle of the anal canal to the rectum changes as well, resulting in a "kink". The kink may prevent stool from emptying normally. When you try to move your bowel by straining, the force of straining is transmitted to the rectovaginal septum, causing the rectocele to form and get bigger.

Symptoms of rectocele

Most rectocele are small and does not cause any symptom. When the rectocele gets big, you may experience:

  • senation of incomplete evacuation with bowel movement

  • need to strain to move your bowel even though stool is soft

  • a noticeable bulge in the back wall of vagina or perineum (the space between the anus and vagina)

  • fullness, heaviness or pressure in the vagina or perineum

  • small amount of fecal seepage between bowel movements (leakage of retained stool in rectocele)

  • need to splint or support the perineum or vagina to help with bowel movement

Diagnosis and treatment of rectocele

Rectocele can be diagnosed by physical exam. A thorough history and exam can also evalaute for any co-exisiting constipation or pelvic floor dysfunction. When a more objective assessment of how the rectocele is contributing to your overall symptoms is warranted (e.g. the size and if the stool is being emptied when you try to defecate), a specific test called MRI defecography may be done.

First-line treatment of rectocele is non-surgical. These include diet modification to achieve easy-to-pass soft formed stool, proper bowel habit (splinting the perineum and vagina instead of straining and spending prolonged time on toilet), and pelvic floor physical therapy. Most people will have significant improvement with these non-operative treatment. If the rectocele continues to cause bothersome symptoms despite above, Dr. Choi may offer surgery. Surgery is usually done transanally (through the anus), the redundant lining (mucosa) over the rectocele is excised, and the wall between the vagina and rectum is plicated (folded and sutured down) to improve its strength.

Helpful links:


*American Society of Colon and Rectal Surgeons