We've discussed pelvic organ prolapse (POP) before on the blog, including the following posts:

•    What is pelvic organ prolapse?
•    Surgery for Pelvic Organ Prolapse: Understanding Native Tissue vs. Mesh-Augmented Surgery
•    Lefort Colpocleisis for the Treatment of Pelvic Organ Prolapse (POP)

Today, we're going to discuss a specific type of prolapse called a rectocele or posterior vaginal wall prolapse. We asked urogynecologist Dr. Dima Ezzedine to answer some FAQs.

As with all content on our blog, the following is meant to be educational in nature, not medical advice. Always consult your physician regarding your unique healthcare needs.

What is a rectocele?

DR. EZZEDINE: A rectocele is a term commonly used to refer to posterior vaginal wall prolapse. It occurs when the back wall of the vaginal canal overlaying the rectum bulges toward (or outside of) the vaginal opening, dragging the rectum with it and creating a rectal sac pushing into the vagina. 

What is the difference between a rectocele and cystocele?

DR. EZZEDINE: A rectocele and cystocele are two different types of pelvic organ prolapse. As opposed to a rectocele, a cystocele occurs when the front wall of the vagina bulges toward (or outside of) the vaginal opening, dragging the bladder along with it. 

A woman with a prolapse can have an isolated rectocele, cystocele, or apical prolapse (prolapse of the top of the vagina). Or she can have any combination of those different types at the same time. 

How common is a posterior vaginal wall prolapse? Is there an average age when they're diagnosed?

DR. EZZEDINE: Rectoceles are very common. They can manifest in women at any time during their adult life, especially after childbirth or after a long-standing history of straining with constipation. 

What causes a posterior vaginal wall prolapse?

DR. EZZEDINE: Just like any other type of pelvic organ prolapse, a posterior vaginal wall prolapse has multiple risk factors, including vaginal childbirth, advancing age, chronic constipation and straining, weight gain, heavy lifting, chronic cough, and connective tissue disorders.

What are some common symptoms of rectoceles?

DR. EZZEDINE: Most rectoceles are in fact asymptomatic. However, many women may experience  pelvic pressure sensation, constipation, incomplete bowel emptying, splinting (applying manual pressure on vagina or perineum to assist in bowel emptying), fecal incontinence, or defecatory dysfunction. 

How are rectoceles diagnosed?

DR. EZZEDINE: Rectoceles are diagnosed during a pelvic examination performed by a specialized provider, such as a urogynecologist. A woman may be asked to exert downward pelvic pressure (for example, bearing down or coughing) to assess for the presence, type, and severity of a prolapse.

Can rectoceles resolve on their own?

DR. EZZEDINE: Rarely, an early stage prolapse may regress on its own or when performing pelvic floor muscle exercises. However, most prolapses reaching the vaginal opening or beyond (stage 2 or more) do not regress spontaneously and may need to be treated, depending on a woman's symptoms. 

What happens if I don't treat my rectocele?

DR. EZZEDINE: A woman with a rectocele who has no symptoms does not need to treat her rectocele. However, a rectocele reaching the vaginal opening or beyond is less likely to regress and more likely to worsen if left untreated, especially in a symptomatic woman. 

How are rectoceles treated?

DR. EZZEDINE: Rectoceles, like all types of prolapse, can be treated surgically or with non-surgical options, such as a pessary. A pessary is a device placed in the vagina that pushes the prolapse inside of a woman's body providing symptom relief. However, It is important for women to understand that a pessary does not eradicate the prolapse. When a woman stops wearing the pessary, the prolapse will return. 

Surgical repairs may involve addressing an isolated rectocele with a vaginal rectocele repair procedure or doing a combined procedure that corrects multiple prolapse compartments depending on the individual patient prolapse presentation.

What are the success rates for surgery?

DR. EZZEDINE: The success rate of a vaginal rectocele repair can reach up to 80%. 

Are there any potential side effects from surgery? For example, will it affect my bowel function or sex life?

DR. EZZEDINE: Rectocele repairs are typically known to improve bowel function as most symptoms of rectocele are related to bowel dysfunction. However, some women may not experience bowel-symptom relief, especially when their symptoms were not—to begin with—due to their rectoceles (such as women with long standing chronic constipation). 

It is very important to undergo a thorough and detailed assessment of symptoms by a specialized provider, such as a urogynecologist, to determine which patient will benefit from a surgical repair of a rectocele versus someone who would benefit from different therapies. 
 
Most women undergoing surgical management of prolapse will experience improvement in their sexual function. The reported rate of a new onset sexual dysfunction after surgery is very low (less than 10%). 

Is it possible to prevent rectoceles?

DR. EZZEDINE: Yes, it is to a certain degree, by avoiding constipation, straining, and heavy lifting.

What else would you like people to understand about rectoceles?

DR. EZZEDINE: Women with symptomatic rectoceles do not need to live with the discomfort and distress of having an ailment affecting their day-to-day activities. As a urogynecologist, I am happy to help them achieve their pelvic health goals. 

If you're experiencing pelvic organ prolapse, like a rectocele, we can help.

Schedule an appointment with one of our urogynecologists.