Rectocele is a form of pelvic organ prolapse that can lead to discomfort, inconvenience, and impaired quality of life. Understanding rectocele, its causes, risk factors, and the benefits of non-surgical treatment options can empower individuals to make informed choices about managing this condition effectively.

What is Rectocele?

Rectocele, also known as posterior vaginal wall prolapse, occurs when the rectum bulges into the vaginal wall due to weakened pelvic floor tissues. This weakening can be due to multiple factors, such as childbirth or age-related changes. As the pelvic floor muscles and ligaments lose strength, the rectum can press into the back of the vaginal wall, creating a bulge that may become noticeable or uncomfortable.

Symptoms of Rectocele

Common symptoms of rectocele include:

• A feeling of pressure or fullness in the pelvic area
• Difficulty with bowel movements, sometimes requiring manual assistance to empty the rectum
• Discomfort during intercourse
• Lower back pain or a sensation of something “falling out” from the vagina in severe cases

Importance of Non-Surgical Treatments for Rectocele

For many, non-surgical options provide effective relief without the risks or recovery time associated with surgery. Non-surgical treatments are especially beneficial for individuals who:

• Prefer less invasive methods
• Want to avoid potential surgical complications, like infections or longer healing times
• Have other health conditions that make surgery a less viable option
• Non-invasive options aim to strengthen the pelvic floor, alleviate symptoms, and improve daily comfort, providing a viable path for those seeking symptom management without surgery.

Causes and Risk Factors of Rectocele

Understanding the underlying causes and contributing factors of rectocele can help individuals prevent its progression and make informed lifestyle adjustments.

Common Causes of Rectocele

Several factors can lead to the weakening of pelvic floor muscles, which then contributes to rectocele:

Childbirth:
Vaginal childbirth, especially if there are complications, can strain and weaken the pelvic floor. Repeated childbirth can increase this risk, as each delivery stretches the muscles and tissues that support the pelvic organs.

Aging and Menopause:
As women age, particularly after menopause, levels of estrogen—a hormone that helps maintain tissue strength—naturally decline. This decrease in estrogen can lead to weakened pelvic tissues, making them more prone to prolapse. Aging also brings general muscle loss, including the pelvic floor.

Connective Tissue Disorders:
Some women are predisposed to conditions that affect the strength and elasticity of connective tissues. Those with conditions like Ehlers-Danlos syndrome or other connective tissue disorders have a higher risk of developing prolapse, including rectocele, because of their inherently weaker connective tissues.

Identifying Risk Factors for Rectocele

While some causes of rectocele are related to life events or genetics, certain lifestyle factors can exacerbate the condition or increase the risk of its development.

Obesity:
Excess weight puts additional strain on the pelvic floor muscles, increasing the risk of prolapse. Maintaining a healthy weight through balanced nutrition and regular exercise can reduce this risk.

Chronic Constipation:
Repeated straining during bowel movements can significantly weaken the pelvic floor over time. Managing constipation through a fiber-rich diet, hydration, and regular physical activity can prevent this strain and reduce the risk of rectocele.

Heavy Lifting:
Regularly lifting heavy objects, especially without proper technique or core engagement, places pressure on the pelvic floor. Occupations or activities that involve repeated heavy lifting can accelerate the weakening of these muscles, increasing the risk of rectocele.

Self-Care Strategies for Those with Rectocele

Taking care of rectocele often involves adopting specific self-care strategies and daily habits to reduce symptoms and support pelvic health. Knowing when to seek medical help and consulting with healthcare providers for a professional evaluation are also essential steps in managing rectocele effectively.

Daily Habits to Minimize Rectocele Symptoms

• Stay Active with Low-Impact Exercises
  • Activities like walking, and gentle yoga can strengthen core and pelvic muscles without placing too much pressure on the pelvic floor. Regular movement supports circulation and helps with weight management, both of which can reduce strain on the pelvic area.
• Practice Proper Lifting Techniques
  • When lifting, engage your core muscles and lift with your legs rather than your back to avoid excess pressure on the pelvic floor. Heavy lifting should generally be avoided whenever possible to prevent worsening symptoms.
• Prevent Constipation
  • Eat Fiber-Rich Foods: A high-fiber diet with plenty of fruits, vegetables, and whole grains can keep your digestive system functioning smoothly. This reduces the need to strain during bowel movements, which is key to minimizing rectocele symptoms.
  • Stay Hydrated: Drinking adequate water also helps prevent constipation and keeps stools soft, easing bowel movements and reducing pelvic pressure.
• Support Your Pelvic Floor with Good Posture
  • Sitting and standing with proper alignment helps maintain core engagement and reduces strain on the pelvic area. Practicing good posture in daily activities can support the body’s natural structure and reduce prolapse symptoms.

Recognizing When to Seek Help for Rectocele

Even with self-care strategies, there may be times when medical guidance is necessary. Knowing when to seek help can prevent further complications and lead to better management.

• Changes in Symptoms

• If symptoms worsen, interfere with daily activities, or cause increased pain or discomfort, consult a healthcare provider. Significant changes, such as difficulty with bowel movements, increased pressure, or noticeable bulging, can indicate a need for professional assessment.

• Impact on Quality of Life

• When rectocele symptoms begin to affect quality of life, causing challenges in daily routines, work, or personal relationships, reaching out for medical advice can provide options to alleviate these challenges.

Consultation with Healthcare Providers Regarding Rectocele

Speaking with a healthcare provider is crucial for accurate diagnosis, personalized recommendations, and a comprehensive treatment plan for rectocele.

Importance of Professional Evaluation for Rectocele

A professional evaluation helps confirm the diagnosis of rectocele and assesses its severity. Healthcare providers can recommend individualized treatment plans based on specific needs and lifestyle. Providers may also suggest physical therapy, prescribe pessaries, or offer other non-surgical options to manage symptoms effectively.

Timing for Considering Surgical Options for Rectocele

Surgery may be considered when rectocele symptoms are severe, do not respond to non-surgical methods, or significantly impact daily life and well-being. Surgical repair is typically recommended as a last resort when other treatments fail to offer relief or when rectocele interferes with bladder or bowel function.

Discussing Surgery with Your Provider: Before deciding on surgery, providers will usually discuss risks, benefits, and what to expect in terms of recovery. Women considering surgery should weigh all options and discuss any concerns with their healthcare provider to make an informed choice.

Using FemiCushion to Treat Rectocele Without Surgery

A study conducted at Showa University Northern Yokohama Hospital, published in The Journal of Obstetrics and Gynecology Research, investigated the effectiveness of FemiCushion in managing pelvic organ prolapse (POP) through MRI evaluations. The study involved twelve women, aged 56 to 84, all experiencing severe stage 3 or 4 POP.

Key Findings

• Effective Repositioning: FemiCushion effectively repositioned prolapsed pelvic organs, achieving results comparable to those of a pessary.
• Lower Risk of Side Effects: Unlike pessaries, FemiCushion was associated with fewer side effects, such as vaginal erosion and bleeding.
• Added Support: The device not only lifted the prolapsed organs but also supported the perineal body and helped close the hiatuses.
• Noticeable Improvement: Participants with severe POP experienced a significant decrease in prolapse severity.
• Rapid Results: Improvements were observed after just one month of use.

These findings suggest that FemiCushion offers a promising non-invasive alternative for managing severe POP, providing similar benefits to pessaries but with fewer associated risks.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.