Rectocele (Bowel Prolapse) Surgery

Rectocele (Bowel Prolapse) Surgery in Turkey: Solving Constipation and Pelvic Discomfort

What is a rectocele? Learn about the connection between chronic constipation, difficult defecation, and vaginal bulges. Expert posterior repair surgery and pelvic floor reconstruction in Istanbul with Dr. Cengiz Andan.

What You Think is Just Constipation Might be an Anatomical Defect

Many women compromise their quality of life for years, believing that their chronic constipation or inability to empty their bowels completely is simply a digestive problem. However, the issue may not be with how the bowels function, but with their anatomical position.

Medically known as Rectocele, and commonly referred to as Bowel Prolapse, this condition occurs when the rectum (the lower part of the large intestine) pushes against the weakened back wall of the vagina, creating a bulge into the vaginal canal.

Normally, a thin wall (rectovaginal septum) separates the vagina and rectum. Due to childbirth, aging, or chronic straining, this wall can weaken. As a result, stool gets trapped in this “pocket” instead of exiting the rectum, making defecation difficult.

At Dr. Cengiz Andan’s Clinic in Istanbul, we recognize that this is not just a “prolapse” but a significant functional disorder. This condition, often hidden due to embarrassment, can be permanently resolved with a 30-45 minute surgical procedure.

1. Why Does a Rectocele Happen? Who is at Risk?

Think of the pelvic floor as a hammock. When the back part of this hammock weakens, a rectocele forms.

Most Common Causes:

• Vaginal Births: Especially difficult labors, vacuum-assisted deliveries, or large babies can tear the posterior vaginal wall.
• Chronic Constipation: Years of excessive straining on the toilet stretches the tissues over time.
• Menopause: Decreased estrogen weakens connective tissue.
• Heavy Lifting: Jobs or activities that constantly increase abdominal pressure.
• Hysterectomy: Previous removal of the uterus can sometimes reduce vaginal support.

2. Symptoms: What is Your Body Telling You?

Rectocele symptoms often worsen later in the day.

• Difficulty Defecating (Obstructive Defecation): The most typical sign. Patients strain to have a bowel movement and feel like stool is “stuck.”
• Splinting (Manual Assistance): Many women need to press on the back wall of the vagina or around the anus with their fingers to push the stool out. This is the clearest sign of a rectocele.
• Vaginal Fullness: A sensation that “something is falling out” or “sitting on a ball.”
• Sexual Issues: A feeling of looseness or lack of sensation during intercourse due to the widened vagina.

Rectocele Grades:

• Grade 1: Mild bulge, usually asymptomatic.
• Grade 2: The rectum descends to the vaginal opening.
• Grade 3: The rectum protrudes outside the vagina (can be felt by hand).

3. Diagnosis

Diagnosis is usually straightforward with a simple gynecological and rectal exam. Your doctor will ask you to strain to determine the severity of the prolapse. In complex cases, Defecography (an X-ray video of defecation) or MRI Defecography may be requested to visualize exactly how the bowel moves.

4. Treatment Options: Is Surgery Necessary?

The treatment plan depends on the severity of symptoms. If the prolapse is mild and you can pass stool comfortably, surgery is not needed.

1. Non-Surgical Methods (For Mild Cases):

• Diet and Lifestyle: High-fiber foods and plenty of water keep stool soft, preventing straining.
• Pelvic Floor Exercises (Kegels): Strengthening the muscles can slow the progression.

1. Surgical Treatment (Posterior Repair / Posterior Colporrhaphy):For moderate to severe prolapse, especially if manual splinting is required, surgery is the definitive solution.

• The Procedure: Performed through the vagina (no abdominal cuts). The excess sagging tissue of the vaginal back wall is removed. The underlying torn muscles and connective tissue (fascia) are tightened and stitched together.
• Added Benefit: This procedure simultaneously tightens the vagina, improving sexual comfort.
• Duration: Takes about 30-45 minutes on average.

5. Recovery and Recurrence

Patient satisfaction after rectocele surgery is very high.

• Hospital Stay: Usually 1 night.
• Pain: Mild soreness when sitting is common, managed with painkillers.
• Bathroom Habits: The first bowel movement might be scary, but stool softeners are prescribed to make it easy.
• Recovery: 1 week of rest at home is sufficient. Full tissue healing and return to sexual activity takes 4-6 weeks.

Will it come back? After a successful surgical repair, the risk of recurrence is low. However, if the patient does not address chronic constipation and continues to strain excessively after surgery, the tissues can stretch again over the years. Therefore, dietary management is part of the cure.

Frequently Asked Questions (FAQ)

1. Does constipation cause rectocele, or does rectocele cause constipation?Answer:Both are true. Chronic constipation and straining cause the rectocele. Once the rectocele forms, stool gets trapped in the pocket, making evacuation harder and worsening the constipation. It’s a vicious cycle.
2. How will surgery affect my sex life?Answer:Positively. While repairing the back wall, the vaginal opening is also tightened (rejuvenated). This eliminates the sensation of prolapse and increases sexual pleasure by restoring friction.
3. Are hemorrhoids and rectoceles the same thing?Answer:No. Hemorrhoids are swollen veins in the anus. A rectocele is the herniation of the rectum into the vagina. However, since both are caused by straining, they often appear together in the same patient.
4. Will there be a visible scar?Answer:No. The entire procedure is performed inside the vagina, so there are no visible external scars.
5. Can I have a normal delivery again?Answer:Normal vaginal delivery is not recommended after rectocele repair, as the birthing process can tear the repair. If future pregnancy is planned, surgery should be postponed until after childbirth, or a C-section should be chosen.

Dr. Cengiz Andan uses anatomical repair techniques to permanently free you from both toilet difficulties and the uncomfortable sensation of vaginal fullness.