Mild rectocele cases produce a sense of pressure or protrusion within the vagina, and the occasional feeling that the rectum has not been completely emptied after a bowel movement. Moderate cases may involve difficulty passing stool, discomfort or pain during evacuation or intercourse, constipation, and a general sensation that something is “falling down” or “falling out” within the pelvis. Severe cases may cause vaginal bleeding, intermittent fecal incontinence, or even the prolapse of the bulge through the mouth of the vagina, or rectal prolapse through the anus.
A rectocele results from a tear in the rectovaginal septum (the divider between the rectum and vagina). Rectal tissue bulges through this tear and into the vagina as a hernia.
Rectocele can be caused by many factors, but the most common is childbirth, especially with babies over nine pounds in weight, or rapid births. The risk increases with the number of vaginal births, although it can also happen in women who have never borne a child. A hysterectomy or other pelvic surgery can also be a cause, as can chronic constipation and straining to pass bowel movements. It is more common in older women because estrogen which helps to keep the pelvic tissues elastic decreases after menopause.
Treatment depends on the severity of the problem, and may include non-surgical methods such as pelvic physical therapy, changes in diet, use of stool softeners, or hormone replacement therapy for post-menopausal women. Surgery to correct rectocele should only be considered when symptoms continue despite the use of non-surgical management, and are significant enough to interfere with activities of daily living.