A rectocele is a type of pelvic organ prolapse where the rectum bulges into the back wall of the vagina. While a rectocele itself does not typically cause direct bleeding, it can contribute to conditions that do. This article explores how rectoceles might indirectly lead to bleeding, and other common causes of rectal bleeding.
What is a Rectocele?
A rectocele forms when the thin, fibrous tissue separating the rectum from the vagina, known as the rectovaginal septum, weakens or thins. This weakening allows the front wall of the rectum to protrude or bulge into the back wall of the vagina. It is a common form of pelvic organ prolapse, often occurring alongside other types of prolapse, such as a cystocele (bladder prolapse) or uterine prolapse.
The primary causes of rectoceles typically involve events that place significant strain on the pelvic floor. Childbirth, especially vaginal deliveries, is a major risk factor. Chronic straining due to constipation also contributes to weakening pelvic floor muscles over time. Other factors include aging and certain gynecological or rectal surgeries.
While small rectoceles may not cause symptoms, larger ones can. Common symptoms relate to bowel movements, such as difficulty emptying the rectum, a feeling of incomplete evacuation, or needing to manually support the vaginal wall. Other symptoms include a sensation of pressure or fullness in the vagina, a noticeable bulge, or discomfort during sexual intercourse.
Rectocele and Associated Bleeding
A rectocele is essentially a structural bulge of tissue, and the tissue itself does not typically bleed directly. However, a rectocele can indirectly lead to rectal bleeding through several mechanisms, primarily by exacerbating or contributing to other conditions. The most common indirect link involves chronic straining during bowel movements. When stool gets trapped in the rectocele, individuals often strain excessively to empty their bowels, which increases pressure in the anal area.
This prolonged or forceful straining can cause hemorrhoids, which are swollen blood vessels in the rectum or anus, or anal fissures, small tears in the anal lining. Both are common causes of bright red rectal bleeding. The blood is usually noticed on toilet paper, in the toilet bowl, or streaked on the stool.
In rarer instances, the vaginal lining of a severely prolapsed rectocele might become irritated or traumatized, potentially leading to minor spotting or vaginal bleeding. This can occur from friction, particularly during attempts to manually reduce the prolapse or assist with defecation. However, any bleeding, especially rectal bleeding, is usually a secondary symptom arising from complications worsened by the presence of a rectocele.
Other Common Causes of Rectal Bleeding
Other common conditions can cause blood in the stool. Hemorrhoids are swollen veins inside or outside the rectum, a frequent cause of bright red blood, often painless unless thrombosed. Anal fissures, small tears in the anal canal lining, also cause bright red bleeding, often with pain during or after bowel movements. Both of these conditions are frequently linked to constipation and straining.
Diverticulosis, where small pouches form in the colon wall, can lead to bleeding if a blood vessel within a pouch erodes. Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, causes chronic digestive tract inflammation and can result in bloody diarrhea, abdominal pain, and weight loss. Colorectal polyps, growths on the colon or rectum lining, may bleed and can become cancerous. Colorectal cancer is a serious cause of rectal bleeding, with blood that might be bright red or darker, sometimes mixed with stool.
Seeking Medical Advice for Bleeding
Any rectal bleeding warrants medical evaluation. While many causes are not serious, such as hemorrhoids or anal fissures, bleeding can also be a symptom of more concerning conditions like inflammatory bowel disease or colorectal cancer.
Seek urgent medical attention if bleeding is heavy, accompanied by dizziness, fainting, severe abdominal pain, or if stool appears black and tarry, indicating bleeding from higher in the digestive tract. When consulting a doctor, provide a complete history of symptoms, including any known rectocele or difficulties with bowel movements, to guide the diagnostic process.