What is the Pelvic Floor?
The pelvic floor is a set of muscles that spread across the bottom of the pelvic cavity like a hammock. The pelvic floor has three openings that run through it, the urethra, the vagina, and the rectum. The functions of the pelvic floor include:
- To support the pelvic organs, specifically the uterus, the bladder, and the rectum
- To help provide sphincter control for the bladder and bowel
- To withstand increases in pressure that occur in the abdomen such as coughing, sneezing, laughing, straining, and lifting
- To enhance the sexual response
What is a Rectocele?
A rectocele, or prolapse of the rectum, is when the rectum bulges into the vagina. A rectocele is different from a rectal prolapsed, where the rectum protrudes through the anus.
The rectum is the last 6 to 8 inches of the large intestine. It expands to store solid waste, and when full its muscular walls contract, forcing waste through the anorectal canal to the anus, where it is expelled from the body.
What Causes a Rectocele?
If your vaginal wall and pelvic floor weaken, your rectum loses its support and can bulge into your vagina. A rectocele often occurs as a result of heavy straining during childbirth. Additionally, as the baby moves through the birth canal, damage to the tissues can occur, sometimes resulting in a rectocele. Other repeated straining such as during bowel movements or heavy lifting can also lead to a rectocele.
As a woman goes through menopause, her estrogen levels fall. This leads to a weakening of the muscles surrounding the vagina, increasing the risk of prolapse.
A mild rectocele - Where the rectum has bulged into the vagina up to the pelvic floor muscles. /A more severe rectocele - Where the rectum has bulged through the entrance of the vagina, through a gap in the pelvic floor.
Other prolapses that can be seen with a rectocele include prolapse of the bladder (cystocele), prolapse of the small intestine (enterocele), and prolapse of the uterus.
How is a RectoceleTreated?
The treatment of a rectocele depends on the severity of it. If your rectocele is mild, pelvic floor strengthening and avoidance of heavy straining can help. More severe rectoceles may require the use of a pessary. A pessary is a device of various shapes and sizes that is placed in the vagina to support the rectum to keep it in place. The most severe rectoceles may require surgery to correct the positioning of the rectum.