A rectocele is a form of pelvic organ prolapse, a condition that occurs when the supportive structures of the pelvis weaken. This weakening permits the rectum to press against and bulge into the back wall of the vagina, creating a hernia-like pouch. The answer to whether a rectocele can cause constipation is yes; this anatomical change frequently results in a specific type of functional constipation known as obstructed defecation.
Defining a Rectocele and Its Causes
A rectocele forms due to a compromise in the integrity of the rectovaginal septum, the thin layer of tissue separating the rectum from the vagina. When this fascial wall loses its strength and elasticity, the pressure from the rectum during a bowel movement pushes the rectal wall forward. This results in the formation of a pocket or bulge that protrudes into the vaginal canal.
The primary risk factors for developing this condition are related to prolonged or intense downward pressure on the pelvic floor. Multiple vaginal childbirths are a common cause, particularly those involving difficult deliveries, the use of forceps, or significant tearing. Chronic straining from long-term constipation or consistent heavy lifting also contributes to the weakening of these support tissues over time.
Natural physiological changes associated with aging and menopause also increase susceptibility to a rectocele. The decline in estrogen levels leads to a loss of collagen and elasticity in the pelvic floor and vaginal tissues. This hormonal change contributes to the overall loss of support structure, allowing the rectal wall to prolapse more easily.
The Mechanism of Obstructed Defecation
The type of constipation caused by a rectocele is distinct from common slow-transit constipation, where stool moves sluggishly through the colon. Instead, a rectocele causes a mechanical blockage referred to as obstructed defecation or outlet obstruction. The issue arises when a person attempts to pass stool and the fecal matter, rather than following the straight path out of the anus, is diverted.
As pressure is exerted during straining, the stool enters the newly formed pocket of the rectocele, effectively filling the bulge. This action pushes the rectal wall further into the vagina, creating a physical kink that prevents the complete and normal passage of waste. The individual feels the urge to evacuate, but the physical blockage prevents the stool from exiting, leaving a feeling of incomplete emptying.
Patients often discover a unique maneuver to counteract this blockage, known as “splinting.” This involves using a finger to apply pressure to the perineum or pressing against the posterior vaginal wall during a bowel movement. This manual support pushes the bulging rectal wall back into alignment, momentarily straightening the passage and allowing the stool to pass. The need for this maneuver is a highly specific indicator that a rectocele is the source of the evacuation difficulty.
Recognizing Common Symptoms
The symptoms of a rectocele can be generally categorized as either rectal or vaginal, often depending on the size of the prolapse. The most common complaint beyond difficulty with bowel movements is a persistent feeling of pelvic or vaginal fullness and pressure. This sensation may be described as feeling like something is “falling out” or is present within the vagina.
Patients frequently report the sensation of incomplete bowel emptying even after a successful movement. Residual stool can remain trapped within the rectocele pouch, sometimes leading to the need to return to the bathroom shortly after. In more pronounced cases, a soft bulge or mass may be visible or palpable at the vaginal opening, which may become more noticeable after standing for long periods.
Other symptoms can include discomfort or pain during sexual intercourse, a condition known as dyspareunia, due to the presence of the prolapsed tissue. While some small rectoceles may be asymptomatic, any combination of these symptoms suggests the pelvic floor support has been compromised. The severity of the symptoms is related to the size of the bulge and its effect on surrounding organs.
Management and Treatment Options
Treatment for a rectocele follows a tiered approach, beginning with conservative management for mild to moderate cases. The initial focus is on preventing the straining that exacerbates the prolapse and its symptoms. This involves dietary and lifestyle modifications, such as increasing fiber intake to 25 grams or more per day and ensuring adequate hydration to produce softer, bulkier stools.
Pelvic floor physical therapy is also a cornerstone of conservative treatment, utilizing exercises like Kegels to help strengthen the surrounding muscles. For cases where the rectocele is larger but surgery is not immediately warranted, a vaginal pessary may be recommended. This is a removable device inserted into the vagina to provide physical support to the prolapsed organs, helping to reduce the bulge and alleviate pressure.
Surgical intervention, typically posterior colporrhaphy, is reserved for patients whose symptoms significantly impair their quality of life or who rely heavily on splinting to defecate. The goal of this surgery is to repair the weakened rectovaginal septum by removing excess tissue and suturing the supportive layers together. This reinforcement restores the anatomical barrier between the rectum and the vagina, eliminating the mechanical obstruction that causes functional constipation.