What is Rectocele (Intestinal Hernia) and Is There a Treatment?

Rectocele, commonly referred to as a rectal hernia, is a pelvic floor disorder that occurs when the rectum bulges toward the posterior wall of the vagina. It is more commonly seen in women with a history of vaginal childbirth, chronic constipation, prolonged straining, or weakened pelvic floor support. In mild cases, it may not cause noticeable symptoms; however, in advanced stages, it can lead to complaints such as difficulty with bowel movements, a feeling of pressure in the vagina, a sensation of incomplete evacuation, discomfort during sexual intercourse, and a significant decrease in quality of life [1][2].

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Although rectocele is often thought of as a bowel-related issue, it is actually an important women’s health condition involving the overall support of the pelvic floor and can affect both comfort and quality of life. Early evaluation increases treatment options.

What Is Rectocele?

Rectocele is the bulging of the rectum toward the posterior vaginal wall due to the weakening of the supporting tissues between the rectum and the vagina. It is a type of pelvic organ prolapse and is medically referred to as posterior vaginal wall prolapse. In mild cases, it may go unnoticed for a long time. In more advanced cases, symptoms such as difficulty during bowel movements, a sensation of fullness in the vagina, and sometimes a palpable bulge may occur [1][2][3].

What Causes Rectocele?

The main cause of rectocele is the weakening of the pelvic floor muscles and connective tissues. As these support structures lose strength over time, the rectum begins to push against the posterior vaginal wall [1][2].

• Difficult or multiple vaginal deliveries
• Pelvic floor trauma during childbirth
• Chronic constipation and long-term straining
• Advanced age and menopause-related tissue changes
• Heavy lifting and physical strain
• Previous pelvic surgeries
• Chronic cough or increased intra-abdominal pressure
• Congenital weakness of pelvic floor structures

In particular, childbirth trauma, chronic constipation, and repeated increases in intra-abdominal pressure play a significant role in the development of rectocele. In some cases, rectocele may occur together with other pelvic floor disorders such as cystocele or uterine prolapse [1][3][4].

Who Is More Likely to Develop Rectocele?

Rectocele can occur at any age but is most commonly seen in women who have had vaginal deliveries and whose pelvic floor support has weakened over time. The risk may increase after menopause due to reduced tissue elasticity [1][4].

Multiple childbirths, chronic constipation, excessive straining during bowel movements, and physically demanding activities can contribute to its development. Therefore, although symptoms are often attributed solely to bowel issues, underlying pelvic floor weakness should always be evaluated [2][4].

What Are the Symptoms of Rectocele?

Rectocele may be asymptomatic in some individuals. When symptoms occur, they typically affect bowel function and vaginal comfort [1][2][3]:

• Difficulty during bowel movements
• A sensation of incomplete evacuation
• Frequent need to strain
• Fragmented or difficult defecation
• Pressure or fullness in the vagina
• A palpable bulge inside the vagina
• Pain or discomfort during sexual intercourse
• A feeling of pressure in the pelvic area

Symptoms may become more noticeable throughout the day, especially after prolonged standing or during defecation. Some women associate rectocele only with constipation, while in others vaginal pressure is the primary complaint [1][2].

For more detailed information about rectocele symptoms and treatment options, you can visit our rectocele treatment page.

How Is Rectocele Diagnosed?

Rectocele is usually diagnosed through a detailed gynecological examination. During the exam, the patient may be asked to strain so that the bulging of the posterior vaginal wall can be observed. Additional tests may be required depending on the severity of symptoms and the presence of other pelvic floor disorders [1][4].

In some cases, imaging methods or functional tests may be used to better evaluate defecation dysfunction, especially when other pelvic organ prolapses are present [4][5].

What Happens If Rectocele Is Left Untreated?

Not all rectocele cases require surgery. In mild and asymptomatic cases, monitoring may be sufficient. However, in symptomatic cases, leaving it untreated may lead to worsening bowel difficulties, increased need for straining, more pronounced vaginal pressure, and a decrease in quality of life [1][2][4].

Treatment decisions should therefore be based not only on anatomical findings but also on symptoms, daily life impact, and overall patient comfort [4][5].

How Is Rectocele Treated?

The treatment approach depends on the severity of symptoms, the degree of prolapse, the patient’s age, associated pelvic floor disorders, and quality of life. Conservative methods are usually considered first, and surgical options are evaluated when necessary [1][4][5].

Dietary Changes and Bowel Habits

One of the first steps in treatment is reducing straining during bowel movements. A fiber-rich diet, adequate fluid intake, and lifestyle changes to relieve constipation are essential. Reducing straining can help decrease the load on the pelvic floor [1][2].

Pelvic Floor Exercises

Exercises aimed at strengthening the pelvic floor muscles can be beneficial, especially in mild to moderate cases. Kegel exercises, when performed correctly and consistently, can help improve pelvic support. In some patients, pelvic floor physiotherapy and biofeedback therapy may also be recommended [4][5].

Surgical Treatment

In cases with significant symptoms, severe impact on bowel function, or when conservative treatments are insufficient, surgical intervention may be considered. The goal of surgery is to repair the posterior vaginal wall and correct the rectal bulging. The specific method depends on the patient’s overall condition and any associated prolapse types [5][6].

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Successful rectocele treatment is not achieved through surgery alone, but also by regulating bowel habits, supporting the pelvic floor, and evaluating the patient’s overall quality of life.

Is Non-Surgical Treatment Possible?

Yes. Especially in mild to moderate rectocele cases, non-surgical treatment options are highly effective. Dietary changes, management of constipation, pelvic floor exercises, and physiotherapy approaches can provide significant relief [1][2][4].

For more information about pelvic organ prolapse, you can visit our uterine prolapse treatment page.

Frequently Asked Questions (FAQ)

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  Can rectocele resolve on its own?

  In most cases, the weakened support structures do not fully recover on their own, but symptoms may improve with lifestyle changes and exercises.

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  Does rectocele cause constipation?

  It may not be the sole cause but can worsen symptoms by making bowel movements more difficult.

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  Does every rectocele require surgery?

  No. Many cases can be managed with conservative treatments.

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  Can rectocele cause pain during intercourse?

  Yes, especially in advanced cases where vaginal pressure is more pronounced.

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  Are Kegel exercises helpful?

  Yes, especially in early stages, they can support pelvic floor strength and reduce symptoms.

References

1. Mayo Clinic
2. Cleveland Clinic
3. ACOG
4. Mayo Clinic
5. ACOG
6. ACOG