Our Approach to Rectocele Treatment at Coyle Institute

Women who have a rectocele can expect excellent care at Coyle Institute. We know how uncomfortable and often painful rectoceles can be, and restoring high quality of life to women who suffer from this condition is one of our passions. It is possible to fully repair and recover from a rectocele and carry on with life as normal. As our patient, your healing and complete recovery is our top priority.

What is a Rectocele?

A rectocele is a type of posterior vaginal prolapse where the supportive wall of tissue between a woman’s rectum and vaginal wall weakens. Without the support of these pelvic floor muscles and ligaments, the front wall of the rectum sags and bulges into the vagina and, in severe cases, protrudes out of the vaginal opening. Most small rectoceles are asymptomatic, but symptoms of introital bulging, constipation, and incomplete rectal evacuation may occur. A rectocele can occur by itself or be present alongside other pelvic abnormalities, such as a prolapsed bladder (cystocele).

What Causes a Rectocele?

It is not possible to pinpoint the exact cause of a rectocele, but contributing factors typically include:

  • pregnancy and childbirth, especially repeated vaginal deliveries and/or tearing or episiotomy during delivery
  • a long and difficult labor
  • assisted delivery during childbirth, including the use of forceps
  • tearing during childbirth, particularly if the tear extends from the vagina to the anus
  • hysterectomy
  • pelvic surgery
  • aging
  • chronic constipation
  • obesity
  • chronic cough or bronchitis

These elements contribute to weakening the tissue between the rectum and the vaginal wall. Over time, this can lead to a rectocele.

What are the Symptoms of a Rectocele?

Mild rectoceles can present without symptoms. However, more severe rectocele symptoms usually involve:

  • rectal pressure or fullness or the sensation that something is stuck in the rectum
  • difficult bowel movement
  • discomfort during sexual intercourse
  • a soft bulge of tissue that can be felt in the vagina or protrudes outside of the body
  • worsening symptoms when standing that ease when lying down
  • lower abdominal pain
  • lower back pain
  • vaginal bleeding that is unrelated to the menstrual cycle
  • fecal incontinence

The symptoms of a rectocele may be vaginal, rectal or both.

How is a Rectocele Diagnosed?

During your appointment, your provider at Coyle Institute will discuss your symptoms and review your medical history with you. A physical exam will then be performed to determine the extent of the rectocele and identify any secondary prolapses if present. Rarely, imaging tests such as ultrasound or MRI may also be performed. During the pelvic exam, you will likely be asked:

  • to bear down as if having a bowel movement. Bearing down may cause the posterior vaginal prolapse to bulge so your provider can assess its size and location.
  • to tighten your pelvic muscles as if you are stopping a urine stream. This test checks the strength of your pelvic muscles

Rectocele Treatment Options

The severity of your rectocele will determine your individualized treatment options. Kegel exercises that strengthen the pelvic floor muscles can naturally repair a mild rectocele. Moderate rectoceles may require a non-surgical pessary, a supportive device inserted into the vagina to support the tissues separating the rectum and the vaginal wall. Severe rectoceles should be treated with surgical repair performed under general anesthesia. The two most common types of surgical rectocele repair involve:

  • a transvaginal rectocele repair, where the rectocele is reached through the vagina. It offers the chance to correct the rectocele, thinned perineum, and widened vaginal opening. In addition, it has the advantage of not disturbing rectal tissues.
  • a transanal rectocele repair, where the rectocele is reached through the anus. This option allows for the correction of problems in the anal or rectal area and repairing the rectocele.


If you believe you may have a rectocele and would like to seek treatment at the Coyle Institute, schedule an appointment today by calling 850-637-8258.