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Rectal Prolapse (Rectocele)

Rectocele occurs when the thin wall of fibrous tissue (fascia) separating the rectum from the vagina becomes weakened, allowing the front wall of the rectum to bulge into the vagina. The bulge will usually increase in size with pressure, especially when having a bowel movement. A large rectocele may make it difficult to have a bowel movement, especially if the patient is constipated. Some women must push the bulge into the vagina to have a bowel movement. Severe cases may cause vaginal bleeding and fecal incontinence. When treatment of rectocele is necessary, self-care measures and pelvic rehabilitation are often effective. In severe cases, surgical repair may be needed.

Up to 20 percent of rectal prolapse sufferers are men, usually elderly and/or afflicted with long-term constipation.

If the rectocele is severe, surgery may be an option. If the rectocele accompanies another condition, such as a cystocele, an enterocele, uterine prolapse, or torn perineum, surgical repair for each condition can be completed at the same time. Surgery usually consists of removing excess, stretched tissue that forms the rectocele. In most cases, this is done using a vaginal surgical approach. Robotically assisted laparoscopic surgery is a minimally invasive alternative. Occasionally, the surgical repair may involve using a mesh patch to support and strengthen the wall between the rectum and vagina.

Causes of Rectocele

Childbirth and other processes that put pressure on the fascia, including coughing, heavy lifting and chronic constipation, can lead to a rectocele. A small rectocele may cause no signs or symptoms. If a rectocele is large, it may create a noticeable bulge of tissue through the vaginal opening. Though this bulge may be uncomfortable, it is rarely painful.

Symptoms of Rectocele

  • Anal pain, discomfort or itching
  • Constipation
  • Loss of urge to defecate
  • Painful bowel movements
  • Anal bleeding or discharge
  • Feeling of incomplete bowel movements
  • Fecal incontinence
  • Lump, bulge or tissue that protrudes from the anus
  • Discomfort or pressure in the vagina
  • Pain in pelvis, lower abdomen, groin or lower back
  • Pain during sexual intercourse

Testing for Rectocele

  • Pelvic exam
  • Rectal exam
  • Defecography – X-rays of the rectum

Treatment for Rectocele

  • Diet/lifestyle modifications
  • Stool softeners
  • Pelvic rehabilitation
  • Pessary placement
  • Pelvic organ prolapse surgery (sacrocolpopexy or proctectomy)
  • Anterior vaginal wall repair surgery with or without mesh augmentation
  • Robotic laparoscopic surgery


Medical Disclaimer: The information provided in the Bladder Health Program of South Florida website should be used solely for educational purposes. It is not intended to replace the independent judgment of a healthcare provider. The appropriateness of a course of treatment for a patient may vary from the medical information provided herein due to individual conditions and/or complications. Always ask your physician about all treatment options, as well as the risks and benefits.

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