What are the treatments for a rectocele?

Anthony L. Komaroff, MD
Internal Medicine
A rectocele is a hernia in the wall that separates the rectum from the vagina.

A hernia is a bulge that forms when the support tissue within the wall is damaged or weakened. Other areas of support in the pelvis can also be damaged. For example, a hernia in the front wall of the vagina that separates it from the bladder is called a cystocele. The general name for these conditions is pelvic floor prolapse.

Treatment is not required for prolapse that causes little or no symptoms. If prolapse is bothersome, several treatments are available:
  • Milder forms of prolapse may improve by practicing Kegel's exercises.
  • A supporting brace (called a pessary) can be worn in the vagina to support the bulging walls.
  • The damaged walls can be repaired surgically.
Gynecologists are trained to evaluate and treat prolapse. Specialists called urogynecologists have added expertise in treating these conditions, especially when surgery is needed.
Kevin W. Windom, MD
OBGYN (Obstetrics & Gynecology)

A rectocele is a hernia in the vagina where the rectum protrudes through a torn area of the connective tissue and bulges into the vagina. Rectoceles are most commonly treated with a plication procedure in which the muscles between the rectum and the vagina are plicated or pulled together over the rectum. This is a very painful procedure and has very poor long-term success. The failure rate of this surgery is 40% to 45%. It is my opinion that rectocele repair should be performed by using either polypropylene or biologic mesh so as to create a barrier between the rectum and the vagina. This surgery can have some complications in which there is a small risk of pain with intercourse as well as a possible risk of the mesh eroding into the rectum or the vagina. The risk of the mesh eroding into the rectum is less than 0.1% and the risk of the mesh eroding into the vagina is 2% to 7%. Some patients can be treated with conservative measures in which estrogen therapy and Kegel exercises can help strengthen the vaginal muscles, this will help decrease the symptoms of a rectocele. Some patients benefit from a pessary usage. A pessary is a rubber device that is placed inside the vagina that will help displace the rectocele and help decrease the patient's symptoms.

In this video, watch as I perform surgery for a rectocele. (Note, this video is not for the faint of heart.)

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.