What Is Rectocele?

A rectocele is a condition in which the lower part of the large intestine (rectum) bulges forward toward the back wall of the vagina, forming a balloon-like protrusion. It is especially common in women after childbirth and often does not cause noticeable symptoms.
Other pelvic organs such as the bladder (cystocele) or small intestine (enterocele) can also herniate into the vaginal area, leading to similar issues.

Causes

Rectocele usually occurs when the connective tissue between the rectum and vagina (rectovaginal septum) becomes thin and weakened, often accompanied by weakness of the pelvic floor muscles.
Contributing factors include:

  • Vaginal childbirth

  • Birth trauma (use of forceps or vacuum, tearing, or episiotomy)

  • Chronic constipation (lasting more than 6 months)

  • Excessive straining during bowel movements

  • Gynecological or rectal surgeries

Symptoms

Small rectoceles are typically asymptomatic.
In larger rectoceles, a bulge inside the vagina may be felt or noticed.

Rectal symptoms include:

  • A feeling of incomplete bowel evacuation

  • Stool getting trapped in the bulging portion of the rectum

  • Needing to press on the vaginal wall or the area between the vagina and rectum to have a bowel movement

  • Excessive straining during defecation

  • The need to pass stool several times a day

  • Constipation

  • Anal pain

Vaginal symptoms include:

  • Pain during sexual intercourse (dyspareunia)

  • Vaginal bleeding

  • A sensation of fullness or pressure in the vagina

Diagnosis

Diagnosis is usually made through physical examination.
However, to assess the severity or to understand the relationship between symptoms and anatomical findings, additional tests may be required.

  • Defecography:
    A specialized imaging technique that shows changes in the rectum and anal canal during defecation. It provides a clear visualization of the size of the rectocele and its relationship to surrounding structures.

Treatment Options

Treatment is recommended when symptoms interfere with daily life.
Before initiating treatment, other conditions that could cause similar symptoms should be ruled out. Both non-surgical and surgical approaches are available.

Non-Surgical Treatment

The goal is to promote easy, regular bowel movements and prevent straining, which helps reduce the risk of worsening the rectocele.

Recommended lifestyle changes and treatments:

  • A high-fiber diet (fruits and vegetables)

  • Adequate water intake (8–10 glasses per day)

  • Avoiding excessive straining during defecation

  • Applying gentle pressure to the back wall of the vagina during bowel movements

  • Kegel exercises and other pelvic floor strengthening exercises

  • Biofeedback therapy: A pelvic floor physical therapy technique that improves rectal sensation and muscle coordination

  • Stool softeners

  • Hormone replacement therapy (when indicated)

Surgical Treatment

If conservative measures fail and the rectocele continues to cause significant symptoms, surgical repair may be considered.
Surgery can be performed via abdominal, rectal, or vaginal approaches, depending on the severity and anatomical features.

Surgical goals:

  • Remove excess tissue caused by the rectocele

  • Strengthen the weakened connective tissue between the rectum and vagina, using surrounding tissues or a surgical mesh (graft) to provide support and restore normal anatomy.