A rectocele is an abnormal bulging of the rectovaginal septum (which
is normally a semi-rigid divider between the rectum and vagina) into
the vaginal area.
It can be caused by many factors, but the most common is childbirth,
especially a difficult birth which involves the use of forceps or a
vaginal tear or episiotomy. 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 be a cause,
as can chronic constipation and straining to pass bowel movements. It
is more common in older women than in younger ones; estrogen which
helps to keep the pelvic tissues elastic decreases after menopause.
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Mild cases may simply 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 (because the attempt to evacuate pushes the
stool into the rectocele instead of out through the anus), 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.
Treatment depends on the severity of the problem, and may include
changes in diet (increase in fiber and water intake), pelvic floor
exercises such as Kegel exercises, use of stool softeners, hormone
replacement therapy for post-menopausal women, insertion of a pessary
into the vagina, and various forms of surgery (usually posterior
colporrhaphy). Both gynecologists and colorectal surgeons can address