A repair procedure isn’t necessary for everyone who develops a rectocele, but it may be the treatment of choice when symptoms can’t be managed conservatively.
A rectocele is a type of pelvic organ prolapse. It occurs when the supportive wall between your vagina and large intestine weakens, allowing tissue from the rectum to push against the back wall of the vagina.
Many people with a rectocele don’t know they have one. They can occur without symptoms and can be a part of aging, the result of vaginal delivery, or a secondary effect from chronic pressure or straining in the abdomen.
When symptoms occur, their severity and how they respond to conservative treatment largely determine whether a repair is needed.
Rectocele repair involves surgical correction of the bulge created by the rectum pushing into the vagina. It’s a procedure reserved for rectoceles that cause significant discomfort or symptoms that don’t respond to other treatments.
No matter which method of rectocele repair is used, the goal is to remove the bulge of tissue and reinforce the rectovaginal septum, the supportive wall between your vagina and the large intestine.
Severe rectoceles often require repair because they can cause serious rectal and vaginal symptoms, including:
- painful sex
- vaginal bleeding
- difficulty passing stool
- rectal pain
- straining during bowel movements
You may even need to press against the vaginal wall with your fingers during a bowel movement to pass stool.
During a rectocele repair, your surgeon separates the vaginal and rectal walls.
The rectovaginal septum is then reinforced through plication, a process of stitching folds of tissue together to increase structural stability. A surgical mesh patch or stapling procedure may sometimes be used as reinforcement.
Once the vaginal and rectal tissues are properly separated and structurally sound, the excess tissue from the prolapse is removed.
Rectocele repair approaches
The one your clinician recommends will be based on factors like age, prolapse severity, and whether your symptoms are primarily vaginal or rectal.
The preferred procedure can also depend on the specialist handling your surgery. Urogynecologists, for example, may gravitate toward abdominal and vaginal procedures, while a colorectal doctor might opt for a rectal approach.
Certain co-occurring conditions can also affect which rectocele repair you have.
The stapled trans-anal rectal resection procedure (STARR), for example, is a method of anal rectocele repair often preferred if you’re experiencing symptoms of rectal obstruction.
No rectocele repair approach is considered better than the others, though the vaginal approach is
If your healthcare professional has recommended rectocele repair, you’ve likely already been through numerous general physical exams, pelvic exams, and contrast tests (defecography) that indicate the presence of a rectocele.
However, preparing for surgery can still involve more lab work to ensure you’re a candidate for anesthesia.
In the weeks before surgery, lifestyle changes like smoking cessation may also be recommended to help decrease the risk of surgical complications.
Once your lab work is approved, you’ll be given specific pre-surgical instructions based on the rectocele repair approach.
Because rectocele repair occurs under general anesthesia, fasting is often required the night before your procedure.
Be sure to tell your care team about any prescription or over-the-counter (OTC) medications and supplements you take. Sometimes, your healthcare professional may recommend adjustments to your dosage or advise on what to avoid leading up to the procedure.
If you’re undergoing an anal approach rectocele repair, bowel prep is necessary to ensure the rectum and intestines are stool-free. This can involve using enemas or stool softeners the day before surgery.
On the day of, follow your surgeon’s hygiene recommendations (if any) and wear comfortable clothing.
The recovery timeline for rectocele repair varies depending on the procedure and factors like age and overall health.
In general, you should plan to be away from work, strenuous activities, and sex for several weeks.
Your surgeon may refer you to a pelvic rehabilitation specialist once your surgical site has healed. A rehabilitation specialist can guide you through pelvic floor strengthening exercises to improve overall pelvic health.
Most of people who undergo rectocele repair report an improvement in their symptoms following the procedure.
In a study from 2011 of 37 females undergoing rectocele repair using the STARR procedure, 87% of participants had results that ranged from “adequate” to “excellent.” A little more than 80% said they would choose to have the procedure again.
You may need to have a follow-up procedure. A 2022 Swedish national cohort
Rectocele repair has a risk of complications similar to any other surgical procedure, such as:
- urinary retention
- allergic reactions to anesthesia
Following recotcele repair, you may also experience:
- new pain during intercourse
- fecal incontinence
- rectovaginal fistula (an opening between the vagina and rectum)
There’s also a chance that, even following successful surgery, the prolapse will occur again and require additional treatment.
There are several nonsurgical strategies for managing rectocele symptoms, including:
- a high fiber diet of more than 25 grams daily
2 to 3 litersof water daily
- stool softeners
- pelvic floor strengthening, like Kegel exercises
- use of a vaginal pessary
Rectocele repair is usually the next step if these approaches don’t provide relief.
Rectoceles are not life threatening, and most don’t require surgical intervention. But your doctor may recommend a repair procedure if your symptoms are severe or can’t be managed with nonsurgical methods.
Though multiple approaches to rectocele repair exist, the ultimate goal is to reinforce the supportive wall between your vagina and rectum and eliminate excess tissue.