A rectocele is a herniation of the rectal wall toward the vagina. Normally, a thin layer of connective tissue termed the rectovaginal septum (fascia of Otto) separates the vagina and rectum. A defect in the rectovaginal septum allows the formation of rectoceles.

Rectoceles may be asymptomatic or may present as bulging into the vagina or protruding from the vaginal opening. Common signs and symptoms include difficulty defecating with manually placing pressure on the vagina or rectum, discomfort or sensation of a rectal mass, tenesmus, constipation, and painful defecation. Fecal incontinence and sexual dysfunction may also occur. Causes include a history of pelvic surgery, chronic constipation, pregnancy, childbirth, decreased muscle tone due to aging or menopause, increased weight on the pelvic floor such as in obesity, continuous heavy lifting, and chronic coughing.

Management may include dietary adjustments (high fiber, increased water intake), stool softeners, and pelvic exercises. A pessary to support weakened vaginal muscles may help. Corrective surgery may be considered if less invasive therapies are unsatisfactory and if pregnancy is no longer a consideration.

Related topic: Uterovaginal prolapse