A rectocele is a type of pelvic organ prolapse in which the wall between the rectum and the vagina weakens, so the rectum bulges into the back of the vagina. It is linked to vaginal childbirth, aging, chronic straining and heavy lifting.
Key symptoms
- Pressure or a bulge felt in the vagina
- Trouble emptying the bowel, a sense of incomplete emptying
- Pressing on the vagina or perineum to pass stool (splinting)
- Discomfort during sex
What you find on exam
- Pelvic exam at rest and while straining
- Bulge of the back vaginal wall, best seen with a split speculum
- Rectal exam to feel the pocket and check sphincter tone
- Check for other prolapse such as bladder or uterus
Tests
- Diagnosis is mostly clinical
- Prolapse staging with the POP-Q system
- Defecography if the picture is unclear or before surgery
- Colonoscopy if there are red flags or screening is due
Treatment basics
- High-fiber diet, fluids and stool softeners; avoid straining
- Pelvic floor physical therapy
- Pessary for patients with symptoms who prefer to avoid surgery
- Surgical repair (posterior colporrhaphy) for bothersome symptoms
Red flags
- Rectal bleeding, weight loss or change in bowel habit
- Ulcer or bleeding of the prolapsed tissue
- Fecal incontinence or bowel obstruction
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.