Ask Doctor K: A rectocele can cause variety of symptoms

DEAR DOCTOR K: I’m a woman in my 60s. I saw my doctor because of rectal pain and constipation. She told me I have a “rectocele.” What does this mean?

DEAR READER: The vagina is separated from the rectum by a wall of tough, fibrous tissue called fascia. Sometimes, an area of this wall gets weak, and part of the rectum bulges into the vagina. This bulge is called a rectocele.

A rectocele usually develops after the vaginal wall is damaged when a baby is born in the normal way, without a cesarean section. But symptoms may not develop until later in life. That’s because the damaged vaginal wall weakens slowly. Rectoceles are often not seen until a woman enters menopause.

Any condition that frequently puts more pressure in the lower pelvis increases the chance that a rectocele will develop. Frequent straining to have a bowel movement because of chronic constipation can do it. So can repetitive heavy lifting. So can a chronic cough, such as from asthma, chronic lung disease or gastroesophageal reflux disease (GERD). Each surge of pressure in the lower pelvis weakens the vaginal wall slightly more.

A small rectocele may not cause any symptoms. Larger rectoceles, however, can trigger a variety of rectal and vaginal complaints. These include:

• A bulge of tissue protruding through the vaginal opening
• Constipation
• Difficulty having a bowel movement
• Pain or discomfort during sex
• A feeling that the rectum has not emptied completely after a bowel movement
• A sensation of rectal pressure
• Rectal pain
• Difficulty controlling the passage of stool or gas from the rectum
• Low back pain that is relieved by lying down.

A rectocele will not heal on its own. It may remain a minor problem, or may become larger and more problematic with time.

If your symptoms are bothersome, your doctor can prescribe a pessary, a device shaped like a ring, block or plug. It is placed into the vagina to support the bulging tissues. It works to fix the problem in many women.

Sometimes, however, surgery is required to repair the weakness in the fascia between your rectum and vagina. This repair may be done by reinforcing the area with stitches. Or it may involve more complex techniques, such as placing a mesh patch to strengthen and support the wall between the rectum and vagina. Surgery usually leads to improvement or complete relief of symptoms.

Many women with a rectocele also have related conditions, including bulging of the bladder into the vagina, or sagging of the uterus into the vagina. This condition is called pelvic organ prolapse. Surgery to repair pelvic organ prolapse can usually be done at the same time as a rectocele repair.

Most of the time, the symptoms caused by a rectocele can be improved by treatments. I’ll bet that’s the case with you.

To send questions, go to AskDoctorK.com or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115