Pelvic organ prolapse is one of the very common problems faced by women. The organs in the pelvis region are held together by the tissues and muscles surrounding them. Due to various reasons when these supporting muscles lose strength, the organs move out of their original place causing prolapse.

Rectocele is one type of pelvic organ prolapse that happens when the separating tissue between the vaginal canal and rectum weakens. Rectocele is also called Posterior Vaginal Wall Prolapse or Proctocele as the rectum pushes the backside wall of the vagina. The protrusion of the rectum into the vaginal wall is even more when passing stools. Rectocele can lead to constipation and discomfort when the protrusion becomes severe.

Other types of pelvic organ prolapse include:

1. Anterior vaginal wall prolapse (cystocele) – a case when the bladder bulges/protrudes into the front wall of the vagina.
2. Uterine prolapse – When the uterus ‘falls’ down through the vagina.
3. Vault prolapse – when the top vault of the vagina bulges down, typically after a hysterectomy procedure.

Symptoms of rectocele

1. Patients with very mild case of rectocele may not have any symptoms. Very mild condition of rectocele is typically found in 40% of women.
2. In mild case of rectocele, the person may feel a little pressure inside the vagina and they may not be able to empty their bowels completely.
3. In moderate rectocele cases, the stool often tends to move into the protrusion instead of getting out of the anus. Passing of stools may be painful and uncomfortable experience.
4. Due to the protrusion of rectum into the vagina, sexual intercourse may become painful.

What causes pelvic organ prolapse?

1. Vaginal child birth is the most common cause of pelvic organ prolapse. It is not just the delivery that damages the tissues and muscles in the pelvis region of a woman, the pressure laid on the muscles while carrying the growing fetus in the womb also hurts the muscles in the pelvis region. Delivering multiple children through the vagina or delivering a large baby can hurt the pelvic muscles more.
2. Severe and chronic constipation – Excess pressure has to be laid on the pelvis region while passing stools. This can lead to damage of tissues and muscles in this region leading to prolapse.
3. Chronic cough or lifting of heavy weights for continued period of time can also damage muscles in the pelvis region.
4. Age – With age, the muscles throughout the body lose strength and those in the pelvis region are no exception.
5. Menopause – As a woman reaches the menopause stage, there will be a change in the production of hormones which reduces the flexibility of muscles in the pelvis region. Loss of elasticity and strength of the muscles in lower abdominal area can lead to pelvic organ prolapse.
6. Obesity – Being overweight or obese can also put more strain on the muscles in the pelvis region.

How is pelvic organ prolapse diagnosed?

Diagnosis of prolapse starts with a series of questions related to symptoms followed by a physical examination of the vagina and the rectum. If your urologist thinks that there might be a different cause of the problem other than the weakening of pelvic muscles, imaging tests might be needed such as CT Scan, X-Ray, or MRI to look into the organs in the pelvis region.

A defecography is a type of X-ray that helps a urologist/doctor determine the extent/severity of the rectocele.

Treatment of pelvic organ prolapse

1. Kegel Exercise is one of the most recommended exercises for women suffering from prolapse or incontinence. This is a proven exercise to strengthen the muscles in the lower abdomen.
2. If the patient is suffering from constipation along with prolapse, he/she will be advised to drink lots of fluids and add more fiber to the diet.
3. Avoiding heavy lifting
4. Losing weight etc may be advised in mild cases of prolapse.
5. Stool softeners may be given to prevent constipation
6. In case of women reaching or who have attained menopause, hormone replacement therapy may be prescribed that help in production of collagen in the muscles of the pelvis.
7. A vaginal pessary may be inserted into the vagina to prevent the protrusion of the rectum.
8. Surgical options also exist in case of severe pelvic organ prolapse. The damaged tissues may be removed and a mesh may be used to support the wall between the vagina and the rectum.

Depending on the severity of prolapse, an appropriate treatment option may be chosen by the urologist treating prolapse.