A rectocele occurs when the rectum bulges into the back wall of the vagina. While not always the primary symptom, a rectocele can contribute to lower back pain in some individuals. This connection stems from physical changes and compensatory mechanisms associated with pelvic organ prolapse. Understanding its impact on the musculoskeletal system helps clarify why some experience back discomfort alongside this condition.
What is a Rectocele?
A rectocele occurs when the tissue between the rectum and the vagina, known as the rectovaginal septum, weakens or thins. This allows the rectum to bulge into the posterior wall of the vagina. It is a form of pelvic organ prolapse, where pelvic organs shift from their normal position. Pelvic floor muscles normally support these organs.
Common factors contributing to a rectocele include vaginal childbirth, especially difficult deliveries. Chronic straining from long-term constipation or heavy lifting can also weaken the pelvic floor. Aging and menopausal hormonal changes further reduce muscle tone and connective tissue strength in the pelvic region.
While a small rectocele may not cause noticeable symptoms, larger bulges can lead to various issues. Symptoms often involve pelvic pressure or fullness, a sensation of something falling out of the vagina, or difficulty with bowel movements. Individuals may experience incomplete emptying after a bowel movement, or need to apply manual pressure (splinting) to facilitate stool passage. Painful intercourse and a soft bulge felt within the vagina are also common.
How Rectocele Can Cause Back Pain
A rectocele can lead to lower back pain through several mechanisms. One way is direct pressure and referred pain. The rectal bulge strains surrounding pelvic floor muscles, ligaments, and connective tissues. This tension and discomfort can be perceived as lower back or sacrum pain due to shared nerve pathways.
Another factor is subtle postural changes individuals adopt to cope with pelvic discomfort or improve bowel function. Leaning forward or changing how one sits or stands to relieve rectocele pressure can misalign the spine and place undue stress on lower back muscles and joints. This compensatory posturing can lead to musculoskeletal strain and chronic back pain.
Less commonly, severe prolapse might irritate nearby nerves, leading to radiating lower back pain. A rectocele often coexists with other pelvic floor dysfunctions, such as levator ani syndrome, which also causes pelvic and referred back pain. In such cases, the rectocele acts as an exacerbating factor, contributing to discomfort and making back pain more pronounced. This interplay highlights the complex nature of rectocele-related back pain.
Addressing Rectocele and Associated Back Pain
If a rectocele is suspected of contributing to lower back pain, medical consultation is the first step. A healthcare professional (gynecologist, urogynecologist, or colorectal surgeon) can diagnose a rectocele through a physical examination. This exam assesses the vaginal canal for prolapse and tests pelvic floor muscle strength. In some cases, specialized imaging like defecography (an X-ray or MRI showing rectal changes during a bowel movement) might be used to evaluate severity.
Treatment for a rectocele often begins with conservative measures. Lifestyle adjustments are recommended, including a high-fiber diet, increased fluid intake, and stool softeners to prevent constipation and reduce straining. Pelvic floor physical therapy, involving exercises like Kegels, strengthens supporting muscles and improves pelvic floor function. Vaginal pessaries, silicone devices inserted into the vagina, provide mechanical support to prolapsed organs and alleviate symptoms.
If conservative approaches do not adequately relieve symptoms, including persistent back pain, surgical repair may be considered. Rectocele repair aims to reduce the bulge and strengthen the weakened tissue between the rectum and vagina, often by stitching supportive layers. This procedure can be performed through various approaches, including transvaginal or transanal routes. The goal of surgery is to restore normal anatomy and improve bowel function, which can alleviate pelvic pressure and back pain.