In a female, the rectum lies just behind the vagina. 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 become stretched and bulge into the vagina. The woman may experience difficulty passing stool.
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 rectum
- chronic constipation or repeated straining during bowel movements
- excessive coughing, such as from lung disease
- menopause. Estrogen helps keep the muscles around the vagina strong. During menopause, estrogen levels decrease.
- normal aging, which can cause the muscles become weaker
What can be done to prevent the disease?
This condition may not be preventable. Using caution when doing heavy lifting may decrease the risk. 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.
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
Long Term Effects
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?
A rectocele is not contagious and poses no risk to others.
What are the treatments for the disease?
If a rectocele is small and does not cause severe or progressively worse symptoms, several treatment measures may be effective:
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
If the rectocele grows in size and causes significant discomfort, a surgery known as a posterior repair will usually be needed. In this procedure, the rectum is moved back into its normal position, the weakened tissue in the wall between the rectum and vagina is removed, and the wall is sewn together so that it will hold firm. Sometimes the wall between the vagina and bladder is repaired at the same time.
What are the side effects of the treatments?
Medications used to treat constipation may cause side effects, including nausea, headache, or diarrhea. Surgery can be complicated by bleeding, infection, or an allergic reactions to the anesthetic.
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 procedure used.
How is the disease monitored?
Any new or worsening symptoms should be reported to the healthcare professional.
http://www.niddk.nih.gov/health/urolog/summary/cystocel/index.htm. Harrison's Principles of Internal Medicine, 1998, Fauci et al.