A rectocele is the result of a tear in the rectovaginal septum (which is normally a tough, fibrous, leaf- shaped divider between the rectum and the vagina). The rectal tissue bulges through this tear and enters the vagina like a hernia. There are two main causes of this tear: childbirth and hysterectomy.
Although the term is more generally applied to the phenomenon of rectal hernia in the vagina in females, males can suffer with a condition named as well. Rectoceles in men are uncommon, and usually the bulge is rearward rather than forward, as the prostate gland provides structural support anteriorly in men. Prostatectomy appears to be associated with rectoceles in men.
Mild cases can simply produce a sensation of pressure or bulging inside the vagina, and the occasional sensation that the rectum has not been completely emptied after a bowel movement. Moderate cases may involve difficulty passing stools (because attempting to have a bowel movement pushes the stool toward the rectocele rather than out the anus), discomfort or pain during bowel movements or intercourse, constipation, and a general feeling that something is "Falling" into the pelvis. Severe cases can cause vaginal bleeding, fecal incontinenceintermittent, or even prolapse of the bulge through the mouth of the vagina, or rectal prolapse through the anus. Digital evacuation, or manual pushing, on the back wall of the vagina helps to aid in bowel movements in most cases of rectocele. Rectocele can be a cause of symptoms of obstructed defecation.
Surgery to correct a rectocele should only be considered when symptoms continue despite the use of nonsurgical management and are significant enough to interfere with activities of daily living. It is usually done by posterior colporrhaphy, which involves suturing the vaginal tissue. Surgery may also involve the insertion of a support mesh (i.e., a patch). There are also surgical techniques aimed at repairing or reinforcing the rectovaginal septum, rather than simply excising or applying the vaginal skin that does not provide support. Both gynecologists and colorectal surgeons can address this problem. Potential complications of the surgical correction of a rectocele include bleeding, infection, dyspareunia (pain during intercourse), as well as recurrence or even worsening of the symptoms of the rectocele. Synthetic or biological grafts should not be used for rectocele repairs.
