Rectocoele

What is a rectocoele?
Rectocoele (or rectocele) is a bulge from the wall of the lower part of the rectum [marked in red in the diagram]. It may occur in men but is more common in women, as a bulge from the lower rectum forwards into the vagina. This bulge occurs as a result of a weakness in the tissues lying between the rectum and vagina (the rectovaginal septum).

What causes a rectocoele?
The most common cause is a weakness of the rectovaginal septum from birth trauma, in particular multiple, difficult births. Repeated straining from anismus may also precipitate the problem. It usually occurs in association with other pelvic floor problems such as intussusception or prolapse.

What symptoms does a rectocoele cause?
The common symptoms from a rectocoele may include a lump in the vagina. Rectal symptoms include difficulty with emptying the bowels and a sensation that stool is getting trapped or going the wrong way during attempts to open the bowels. Leakage of a small amount of stool after visits to the toilet is common. Many patients have to press with the finger on the back wall of the vagina or on the perineum (the skin between the anal canal and vaginal opening) or in the anus to help them to empty.

How is it diagnosed?
We often suspect the diagnosis on the basis of symptoms and examination in clinic. You will need tests and a proctogram is the one that usually confirms the diagnosis.

How can a rectocoele be treated?
Treatment for an isolated rectocoele is usually performed through the anal canal. If there are other associated problems, laparoscopic ventral rectopexy through the abdomen is more appropriate.