A rectocele is a form of pelvic organ prolapse where the rectum, the lower part of the large intestine, bulges into the vagina. This occurs when the supportive tissue wall between the rectum and the vagina, known as the rectovaginal septum, becomes weakened or damaged. As a result, the rectum can push forward, creating a noticeable bulge. Healthcare providers classify rectoceles based on their severity using a standardized grading system.
Common Symptoms and Causes of a Rectocele
A rectocele arises from weakening pelvic floor muscles and connective tissues that normally support pelvic organs. Several factors contribute to this weakening, including vaginal childbirth, especially if there were multiple deliveries, difficult labors, or procedures like forceps use or episiotomies. Chronic conditions that increase pressure on the pelvic floor, such as long-term constipation with straining, persistent coughing, or regular heavy lifting, can also lead to a rectocele. Hormonal changes associated with menopause and increasing age further contribute to the loss of tissue strength.
Individuals experiencing a rectocele may encounter various symptoms, although small rectoceles might not cause noticeable issues. Common complaints include a sensation of pressure or fullness within the vagina, or feeling as though something is falling out. Bowel movement difficulties are frequent, such as straining to empty the bowels, a feeling of incomplete evacuation, or even needing to press on the vaginal wall to help pass stool. Some people also report discomfort during sexual intercourse or lower back pain.
Understanding Rectocele Grades
The severity of a rectocele is categorized into different grades, which helps healthcare providers determine the extent of the prolapse and guide treatment decisions. A common approach uses a scale from mild to severe, related to how far the bulge extends toward or past the vaginal opening. These grades describe the anatomical presentation and correlate with the intensity of symptoms experienced.
Grade 1 (Mild)
A Grade 1 rectocele represents the least severe form of the condition. In this stage, the rectal bulge is small and remains entirely within the vaginal canal, not reaching the vaginal opening. Individuals with a mild rectocele experience no symptoms, or only subtle sensations of pressure. The prolapse is detected incidentally during a routine pelvic examination.
Grade 2 (Moderate)
In Grade 2, the bulge extends further down the vaginal canal, reaching closer to or even to the vaginal opening, especially with increased abdominal pressure, such as during straining or coughing. Symptoms become more common and pronounced. Patients may notice a more definite feeling of pressure or a visible bulge, and difficulties with bowel movements, like needing to digitally assist evacuation, become more frequent.
Grade 3 (Severe)
A Grade 3 rectocele signifies a severe degree of prolapse, where the rectal bulge protrudes consistently outside the vaginal opening. This outward protrusion can be noticeable and may cause significant discomfort. Symptoms associated with severe rectoceles are more intense and consistently present, including more pronounced difficulty with bowel movements, a constant sensation of something “falling out,” and potential issues with vaginal irritation due to exposed tissue.
How a Rectocele is Diagnosed and Visualized
Diagnosis of a rectocele primarily involves a physical pelvic examination. During this exam, the doctor will observe the vaginal walls and may ask the patient to relax and then “bear down” or strain, similar to having a bowel movement. This action allows the provider to assess the presence, size, and location of any bulge, which helps in determining the rectocele’s grade. The strength of the pelvic floor muscles may also be evaluated during this examination.
Public articles use medical illustrations rather than actual photographs to depict rectoceles. These illustrations provide a clear visual representation of the anatomical changes at different grades. For a Grade 1 rectocele, illustrations show a slight indentation or bulge of the rectum into the posterior vaginal wall, remaining high within the vagina. Grade 2 illustrations depict the bulge extending further, nearing or reaching the plane of the vaginal opening. In Grade 3 illustrations, the rectal bulge is clearly shown protruding outside the vaginal opening.