By | June 8, 2022

A rectocele is a bulging of the front wall of the rectum into the vagina. It is often accompanied by a descent of the pelvic floor.

What is a rectocele?

A rectocele is when there is a bulging of the rectum. This causes a protrusion into the female vagina directly above the sphincter muscles. For meanings of colon cancer, please visit

In most cases, the rectocele bulges towards the vagina or urinary bladder. Only women are affected. The bulging is associated with the general sinking of the lower intestines. The pelvic floor gives way under pressure.

In addition, there are disturbances in the emptying of the stool.

A rectocele is found in about 50 percent of all women older than 50 years of age during medical examinations. However, therapy only takes place if those affected suffer from symptoms.


The causes of the development of a rectocele have not yet been fully elucidated. It is not uncommon for those affected to suffer from a descent or insufficiency of the pelvic floor, which entail changes in the usual anatomy. There are some known risk factors that can promote the occurrence of a rectocele.

These include pregnancies, natural births, chronic constipation, gynecological surgery, advanced age, obesity and significant straining movements when having a bowel movement. Due to anatomical conditions, a rectocele only occurs in females. The male sphincter muscles are equally strong, while the outer sphincter muscles on the front of women become thinner and thinner.

In addition, the prostate (prostate gland) in men causes the intestines to expand forward. However, women do not have such anatomical obstacles. Several births and the weakening of the connective tissue can cause the pelvic floor to shift downwards with increasing age. There is then enough space under the bony ring for the rectum to expand, which expands without resistance.

Symptoms, Ailments & Signs

When the rectocele grows to a certain size, there are severe problems with defecation. For this reason, rectoceles are considered a common trigger for obstructive defecation syndrome (ODS). If a woman has been constipated for several years, she hardly notices the changes because they only progress slowly.

Typical symptoms of a rectocele are strong and prolonged straining when emptying the stool, eczema, itching, the appearance of blood or mucus when emptying the stool, pain in the rectum or perineal region and the passing of the stool in several sections. It is not uncommon for patients to have to resort to laxatives in order to defecate at all. Sometimes there are also ulcers within the rectum, which doctors call a solitary rectal ulcer.

The symptoms can be so intense that they significantly affect the quality of life of the affected women. They are caused by the fact that the rectocele is filled with stool before emptying. If there is also a lowering of the pelvic floor, the angle of the rectum and anus changes. Therefore, when you press, the pressure is not transferred to the anus, but to the rectocele.

The wall of the rectum is so thin in the rectocele area that it no longer has functional muscles. The rectum wall is longer in the front direction. When the rectum is empty, folds form that fall towards the anus. This incident is known in medicine as a rectal prolapse.

Diagnosis & course of disease

The diagnosis of a rectocele is difficult and time-consuming, since it and its symptoms often only develop over a number of years. First, the medical history of the patient is drawn up. Then the doctor performs a physical examination, which usually reveals a lowering of the perineum. A sphincter muscle weakness is often detected as part of a digital scan.

Another examination option is endoscopy, which consists of rectoscopy or proctoscopy. Sometimes further examinations such as a colonoscopy to clarify a constipation or gynecological examinations are carried out. Defecography is considered crucial for the diagnosis of a rectocele.

With this procedure, the rectocele can be visualized with the aid of a contrast agent when the stool is being defecated. A rectocele does not always cause symptoms. However, larger protrusions can cause drainage problems, requiring medical attention.


Rectoceles very often cause no symptoms and therefore often do not require treatment. However, larger rectoceles can lead to symptoms and complications that require at least conservative treatment or, in rare cases, surgical intervention. Especially older women or women who have had multiple pregnancies, including overweight women, are more likely to suffer from a larger rectocele.

The so-called obstructive defecation syndrome can occur as a complication in these cases. Chronic constipation is the main feature of this syndrome. The affected women suffer from a constant urge to defecate, which is associated with the persistent feeling of incomplete emptying. In addition to abdominal pain, constant discomfort and nausea, faecal incontinence can also develop over time.

Furthermore, larger rectoceles are often characterized by excruciating itching and eczema in the anal area. There is often pain in the perineal area, with the laboriously pressed stool being covered with blood and mucus. Sometimes even ulcers develop in the rectum, which are also known as rectal ulcers.

The quality of life of women can be so impaired that it can lead to psychological problems. Some women suffer from depression or other mental illnesses as a result of the chronic symptoms. In rare cases, the symptoms can become so severe that an operation is necessary. The surgical risks depend on the extent of the surgical intervention required.

When should you go to the doctor?

A rectocele should always be treated by a doctor. Further complications can only be avoided by medical treatment. This disease does not heal itself. The doctor must be consulted for rectocele if the person concerned has been constipated for several years. Constipation can be sporadic or chronic. If these symptoms are present, medical treatment is necessary. It can also lead to itching after defecation at the anus, since the affected person has to push hard during defecation.

In some cases, patients also resort to laxatives to relieve the discomfort of the rectocele. If these symptoms occur over a longer period of time and do not heal on their own, a doctor must be consulted. The rectocele is treated by an internist, proctologist or general practitioner. Further treatment depends heavily on the exact severity of the symptoms.

Treatment & Therapy

Usually, a rectocele is treated conservatively at first. This involves changing the patient’s diet. She is also given stool softening drugs. Furthermore, the patient receives preparations that increase the intestinal transport speed. Physiotherapeutic measures take place when there is a weakening of the pelvic floor muscles or coordination problems.

If complications such as ulcers, a rectal prolapse or bleeding occur, or if the rectocele is large, surgery is usually required. The STARR operation or a posterior vaginal tightening can be considered as surgical methods. As part of the STARR procedure, the surgeon removes a cuff of the rectum four to eight centimeters wide over the anus.

In posterior colporrhaphy, it strengthens the space between the rectum and vagina and the posterior vaginal wall, thereby counteracting further expansion of the rectocele.


To prevent a rectocele from occurring in the first place, women are recommended to consistently undergo postnatal and pelvic floor exercises after childbirth. Training of the anal sphincter should also be considered.


Follow-up care for a rectocele depends on the course of the condition. A small rectocele does not always need treatment. A one-time follow-up examination is usually sufficient. Unless the patient shows any unusual symptoms, no further action is required. In individual cases, an injection treatment takes place and the family doctor has to ask as part of the follow-up care whether side effects or medical complications are occurring in the patient.

After an operation, as is necessary for a protracted rectocele, there is usually a short stay in the hospital. The chief physician checks the surgical wound and takes an anamnesis. If necessary, the prescribed medication must be adjusted or discontinued. Even with a surgical intervention, the further procedure depends on the course.

In the case of an operation, aftercare is provided by the responsible chief physician. In most cases, the patient’s house gynecologist is also included in the follow-up care. If the rectocele proceeds well, the patient can be discharged. The doctor will inform you about any risks and encourage you to have regular routine check-ups. Further follow-up care is usually not necessary for a cured rectocele.

You can do that yourself

The rectocele can be partially alleviated in its disturbing symptoms with self-help. This applies in particular to emptying the stool, which is often hampered by the sac-like protuberance when pressing. To what extent self-help is possible and what it looks like is best discussed with the treating doctor or a specialized physiotherapist.

Defecation is an important issue in the patient when it comes to rectocele. Here it is important to take targeted measures to make bowel movements easier. Strong straining in particular should be avoided, as this intensifies the rectocele and makes bowel movements particularly difficult. So constipation is particularly troublesome in rectocele. Therefore, stool regulation as self-help is very important. This can be achieved by eating a diet rich in fiber and drinking enough water. Physical exercise is also helpful as it can naturally stimulate bowel movements. If these measures are not enough, psyllium preparations are helpful. This should only be taken after consultation with the doctor treating you.

The rectocele can also be influenced somewhat with pelvic floor exercises and training of the vaginal muscles. The exercises can be learned by physiotherapists and gynecologists and are designed for regular use at home. In general, the bowel movement should only last a short time. Sitting on the toilet for a long time aggravates the symptoms. Patients would rather go to the toilet again later than induce a bowel movement by pressing hard.