Bowel Prolapse (Rectocele): Causes, Symptoms, and Treatment Methods

Bowel prolapse, known medically as rectocele, is the bulging or sagging of the rectum (the final part of the large intestine) into the posterior (back) wall of the vagina. It occurs as a result of the weakening of the muscles and connective tissues that support the pelvic floor. It is more common in women, especially those who have had multiple deliveries, are in the postmenopausal period, or have undergone pelvic surgery.

Grades of Rectocele

• Mild (Grade 1): The rectum bulges slightly into the vagina.

• Moderate (Grade 2): The rectum descends to the vaginal opening.

• Severe (Grade 3): The rectum protrudes (bulges) out of the vaginal opening.

Causes

• Difficult or multiple vaginal births

• Estrogen decrease after menopause

• Chronic constipation

• Obesity

• Habitual heavy lifting

• Tissue weakness after pelvic surgery

Symptoms

• A feeling of fullness or pressure in the vagina

• Difficulty with defecation (bowel movements)

• The need to press on the back wall of the vagina with a finger to have a bowel movement (splinting)

• Constipation

• Discomfort during sexual intercourse

• Back and pelvic (groin) pain

Diagnostic Methods

• Gynecological and rectal examination

• Defecography (imaging during defecation)

• MR defecography

• Colonoscopy, if necessary

Treatment Methods

1. Non-Surgical Methods

• Pelvic floor muscle exercises (Kegels)

• Treatment of constipation and a high-fiber diet

• Avoiding heavy lifting

2. Surgical Methods

• Posterior vaginal wall repair (Posterior Colporrhaphy)

• Rectocele repair (surgical reinforcement of tissues)

• Augmentation (support) with mesh (in appropriate cases)

Preventive Methods for Rectocele

• Performing regular pelvic exercises after childbirth

• Implementing a high-fiber diet

• Treating chronic constipation

• Avoiding heavy lifting

Rectocele Treatment in Istanbul

As Assoc. Prof. Dr. Cengiz Andan, I offer comprehensive evaluations and personalized treatment options for patients with rectocele. Our goal is to both improve quality of life and minimize the risk of recurrence.

Frequently Asked Questions (FAQ)

Does a rectocele resolve on its own? No, but early stages that do not require surgery can be managed with lifestyle changes.

Can a rectocele recur after surgery? The risk of recurrence is low with the correct surgical technique and preventive measures.

Does constipation worsen a rectocele? Yes, chronic constipation accelerates the progression by putting excessive strain on the pelvic floor.