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Rectocele is a bulging (herniation) of the rectal lining towards the vagina through a weakened/ damaged wall between the rectum and the vagina. If it is very advanced it can present as a lump falling through the vaginal opening onto the perineum, originating from the back wall of the vagina.

If it is less far advanced it will not become visible in the vaginal orifice, but still allows for the stool to get lost during defecation in a pocket on the front of the rectum, instead of nicely coming out through the anus. 

Rectocele develops from traumatic vaginal delivery, from pregnancies, from ageing as an isolated phenomenon or as part of POP (pelvic organ prolapse).

What signs and symptoms one has with this problem?

Rectocele is one cause for obstructed defecation type of constipation. It is one of the frequent causes. Usually the stool consistency and the frequency of defecation is normal, still the patient is struggling on the toilet.

Patients describes difficulty emptying the rectum (obstructed defecation) and after emptying still feels some content remaining in the rectum (incomplete evacuation). Some patients report the need for digitation: i.e. the use of fingers to help emptying either by supporting or pulling apart the perineum outside or supporting the beck wall of the vagina to push back the bulge or with direct anal digitation aiming to “pull the stool out”. This type of struggle then can lead to bleeding and pain, however it is not primarily part of the rectocele symptom complex.

Normal Pelvis

Rectocele Grade 1-2

Rectocele Grade 3-4