At my six-week postpartum check-up following the birth of my second child, my healthcare provider, Dr. Sarah, examined me and cheerfully mentioned that I had a rectocele. Initially confused, I learned that this condition occurs when the rectum bulges against the vaginal wall, often becoming noticeable during constipation.
Great, just what I needed!
Dr. Sarah reassured me that my rectocele was relatively minor, likely a consequence of childbirth (let’s just say the delivery was quite eventful), and suggested that strengthening my pelvic floor could help reposition the rectum more favorably. At the time, I didn’t give it much thought, caught up in the whirlwind of raising young children. I focused on doing my Kegel exercises (when I remembered), hoping for the best and worrying about worse outcomes.
Fast forward a few years, and as I approach my 40s, I’ve noticed that my rectocele is becoming more bothersome. Without going into too much detail, it sometimes feels like my rectum is encroaching on my vaginal space (rest assured, it isn’t literally!). This prompted me to delve deeper into understanding rectoceles and whether I could alleviate my discomfort.
Surprisingly, about 40% of women experience rectoceles, though many remain unaware due to the mild nature of the symptoms. According to the American Society of Colon and Rectal Surgeons, the absence of severe symptoms is why many women aren’t familiar with this condition.
Common Symptoms of Rectoceles
For those who do experience symptoms, they often include:
- Increased vaginal pressure, especially during constipation.
- Difficulty with bowel movements or a feeling of incomplete evacuation.
- Occasionally, women may need to assist with bowel movements by inserting a finger into the vagina—yes, this is clinically recognized guidance.
- Other symptoms can involve discomfort during intercourse, vaginal bleeding, or a noticeable bulge within the vagina. In more significant cases, symptoms may escalate to fecal incontinence or “smearing.”
These issues arise from weakened pelvic muscles and the rectum’s prolapse against the vaginal wall. Anatomically, this can be subtle, but when comparing a normal vagina to a rectocele, the difference is evident, with less space between the two structures. Prolapses can also affect nearby organs, such as the bladder or uterus, and can be exacerbated by childbirth and aging, in addition to chronic constipation.
Managing a Rectocele
So, what can be done for a bothersome rectocele?
Recommendations from the Mayo Clinic include making lifestyle modifications aimed at alleviating symptoms. This entails consuming a high-fiber diet and staying well-hydrated to prevent constipation. It’s advisable to avoid excessive straining during bowel movements, heavy lifting, and deep coughing, all of which could worsen the condition. And yes, regular Kegel exercises are essential—not just for toning the vagina but for maintaining the integrity of the pelvic floor. Proper technique is crucial, and seeking physical therapy for pelvic organ prolapse is worth considering (this may be covered by your insurance).
If conservative measures fail to provide relief, surgical options are available. However, as noted by the American Society of Colon and Rectal Surgeons, surgical risks include bleeding, infection, new onset of dyspareunia (pain during intercourse), fecal incontinence, rectovaginal fistula, and the possibility of recurrence or worsening of the rectocele.
On a positive note, initial surgical success rates are promising, with 75–90% of patients reporting improvement. Unfortunately, this success rate can drop to 50–60% after two years. Deciding whether to pursue surgery is a personal journey that should be discussed with your healthcare provider.
Conclusion
In summary, rectoceles, like other common conditions related to childbirth and female anatomy, can be challenging but are not uncommon. It’s important to understand that you’re not alone in this experience, and there are steps you can take to manage the symptoms effectively. After all, no one wants to feel like their rectum and vagina are too closely acquainted!
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