A rectocele doesn’t make your body produce more gas, but it can leave you bloated by making it harder for stool and gas to leave. The problem is things getting stuck on the way out, not too much gas being made, and that changes what tends to help. The bloating often comes as much from bowel and pelvic floor problems that commonly travel with a rectocele as from the bulge itself.
How a Rectocele Traps Stool and Gas
A thin wall of tissue normally separates the rectum from the vagina. When that wall weakens or tears, the front of the rectum pushes into the vagina and forms a bulge, which shows more when you strain.1PubMed. Rectocele A related problem, where the rectal wall folds in on itself, comes from the same weak support.2PubMed. The surgical anatomy of rectocele and anterior rectal wall intussusception Childbirth, ageing, and years of straining are the usual reasons the wall gives way.
Women with a rectocele commonly report pelvic pressure, constipation, and trouble getting stool out.3PubMed Central. Rectocele When you push, some stool goes forward into the bulge instead of out, so the rectum never fully empties. Gas behind that stool can’t pass easily either. Gas trapped by a blocked exit can cause as much belly swelling as gas held up by a slow gut, and it may feel worse.4American Journal of Physiology-Gastrointestinal and Liver Physiology. Mechanisms of intestinal gas retention in humans: impaired propulsion versus obstructed evacuation
Day to day, this bloating often builds through the day and eases after a full bowel movement. Many women feel they haven’t finished even right after going. The gas may feel stuck low in the pelvis rather than high in the belly, and passing it can be hard, or it may come in bursts after straining. Cutting gassy foods alone often doesn’t fix things, and better emptying tends to matter more than eating less.
The pocket also tends to refill. Stool that slips into the bulge often stays there after you stand up, so the rectum can feel partly full again soon after you leave the toilet. The pocket is part of the rectum’s own wall, so it can’t squeeze its contents out the way the rest of the rectum does, and pushing harder often doesn’t help. Over days, a small amount of stool can sit in it most of the time, adding to pressure and fullness.
The bulge alone doesn’t prove it’s your cause, either. Many women have a rectocele found on an exam and never notice bloating or trouble emptying. What matters is whether stool actually gets caught in it, which is why symptoms such as needing to press to empty tell a doctor more than the exam finding by itself.
Gut Bacteria and Methane in Rectocele
Among people with constipation, about 1 in 3 with a rectocele had a positive methane breath test, versus about 1 in 4 with ordinary constipation and fewer than 1 in 10 healthy people.5PubMed Central / Revista Española de Enfermedades Digestivas. The association between a positive lactulose methane breath test and rectocele in constipated patients Higher methane levels also went along with slower movement through the lower colon in people with a rectocele.6PubMed Central / Revista Española de Enfermedades Digestivas. The association between a positive lactulose methane breath test and rectocele in constipated patients
Some microbes in the gut turn hydrogen made by other bacteria into methane, a gas that tends to slow the muscle movement of the intestine. Slower movement means food residue sits longer, giving bacteria more time to make gas, which is how a loop can form. These microbes are a normal part of some people’s guts, so having them is not an infection.
The breath test is simple. You drink a sugar solution and breathe into bags at intervals, and methane in your breath points to gas-making bacteria. If bloating persists despite better emptying, ask your doctor whether it’s worth doing. A positive result can explain bloating that seems bigger than the rectocele alone, and doctors may consider treatment aimed at the bacteria.
The finding comes with limits. It comes from one group of constipated patients and shows a link, not proof that the rectocele causes it.7PubMed Central / Revista Española de Enfermedades Digestivas. The association between a positive lactulose methane breath test and rectocele in constipated patients A breath test can show methane is present, but not whether it came before the slow bowel or after it. Because the study looked at people who were already constipated, it says little about women with a rectocele who aren’t.
Other Problems That Often Come With a Rectocele
Some people’s pelvic floor muscles clamp down instead of letting go when they try to pass stool. Left untreated, it commonly leads to problems such as anal tears, rectocele, and rectal prolapse.8Gleneagles Hospital. Understanding Dys-synergic Defaecation So years of pushing against tight muscles can help cause the rectocele in the first place. Difficult emptying is also a common cause of stubborn bloating that doesn’t respond to usual measures.9PubMed. Pelvic floor biofeedback is an effective treatment for severe bloating in disorders of gut-brain interaction with outlet dysfunction
Many people with it feel they are pushing hard but nothing moves, as if the exit is shut, which is the opposite of a weak push. Some need a suppository, enema, or finger pressure to pass stool, even when it isn’t hard. Because the symptoms can look just like a rectocele, the two are easy to mix up without testing. A rectocele found on exam may get the blame when tight muscles are the main reason stool doesn’t pass. The two can exist together, and testing how the muscles coordinate is the way to sort out which is leading.
IBS overlaps with prolapse too. Women with IBS are about 2.4 times as likely to report bothersome pelvic organ prolapse.10PubMed Central. Pelvic floor disorders and quality of life in women with self-reported irritable bowel syndrome They report weekly constipation about twice as often as women without IBS, 23% versus 11%, and are about 4 times as likely to be strongly bothered by prolapse symptoms.11PubMed Central. Pelvic floor disorders and quality of life in women with self-reported irritable bowel syndrome So bloating in a woman with a rectocele may partly come from IBS, which makes the gut more sensitive to normal gas.
A few clues point beyond the rectocele. Belly pain that eases after a bowel movement can suggest IBS. Bloating with loose stools as well as constipation points elsewhere, and straining even when stool is soft suggests muscles not relaxing. Bloating high in the belly after meals may have other causes worth checking. Repairing the bulge won’t fix muscles that don’t coordinate, and IBS needs its own care alongside rectocele treatment.
Splinting to Empty More Completely
Many women with a rectocele press on or inside the vagina to help pass stool, which is called splinting.12PubMed Central. Rectocele Most who splint press on the vagina, while others press on the area between the vagina and anus or on the buttock.13PubMed Central. Assessment of Women With Defecatory Dysfunction and Manual Splinting Using Dynamic Pelvic Floor Magnetic Resonance Imaging In nearly all of them, splinting at least partly pushed the bulge back during a bowel movement, as seen on MRI, and pressing on the vagina fully corrected it about half the time.14PubMed Central. Assessment of Women With Defecatory Dysfunction and Manual Splinting Using Dynamic Pelvic Floor Magnetic Resonance Imaging Emptying more fully can leave less stool and gas behind to cause bloating.
To try it, wash your hands and use a clean finger or two, or a tissue on the area between the vagina and anus. Press gently backward on the back wall of the vagina while you bear down. A footstool that raises your knees above your hips helps, and so does breathing out slowly rather than holding your breath and straining hard.
Splinting tends to help most when stool feels stuck or you can’t finish emptying despite pushing. Needing it every time suggests stool may be getting caught in the bulge.
Pressing on the back wall of the vagina supports the bulge directly, which suits most women. If that doesn’t work, pressing on the skin between the vagina and anus can be gentler. Women who find neither helps may be dealing with a different problem, worth mentioning to a doctor.
Splinting is a widely used technique and is generally considered safe. Needing to splint more over time is worth telling your doctor.
How Doctors Find the Cause
A clinician usually examines you lying down and sometimes also while you bear down, since a rectocele shows more with pushing. A finger exam of the rectum can show how the muscles squeeze and relax and whether there is a pocket in the front wall. The exam is often the first clue, but the size of the bulge doesn’t always match how much it bothers you.
A pressure test of the anus and rectum and a test where you push out a small water-filled balloon check how well your muscles coordinate. These can hint at a large rectocele, but imaging is needed to confirm it.15PubMed Central. Comparison of Anorectal Manometry, Rectal Balloon Expulsion Test, and Defecography for Diagnosing Defecatory Disorders Doctors use defecography, an X-ray or MRI taken while you empty your bowels, when a structural problem is suspected.16PubMed Central. Comparison of Anorectal Manometry, Rectal Balloon Expulsion Test, and Defecography for Diagnosing Defecatory Disorders It is especially useful when the muscle tests give unclear or conflicting results.17PubMed. Imaging and clinical assessment of functional defecatory disorders with emphasis on defecography Rectoceles 3 cm or larger are generally the ones considered large.18PubMed Central. High-resolution Rectoanal Manometry for Identifying Defecatory Disorders and Rectal Structural Abnormalities in Women
For the test, a thick paste is placed in the rectum, sometimes the vagina too. You sit on a special seat and empty while images are taken. It can feel awkward but is usually short and not painful, and it shows whether stool gets caught in the bulge.
Many women are treated based on the exam and symptoms alone, with imaging saved for unclear cases or when surgery is being considered. Imaging helps when the exam and symptoms don’t match or more than one pelvic problem may be involved, and it can reveal other causes of similar symptoms, such as the rectum folding in on itself. A gynecologist or urogynecologist often finds the rectocele first, while a gastroenterologist or colorectal surgeon handles bowel testing.
Treatments That Ease Rectocele Bloating
Most people start with diet, fluids, toilet position, and splinting. Adding lots of fibre, especially the insoluble kind like bran, can increase bloating without making bowel movements more regular.19Bladder & Bowel UK. Rectocele and Incontinence: A Patient’s Journey to Improved Bowel Function Increase fibre slowly and favour soluble types such as oats and psyllium. Psyllium is usually started at a low dose and raised over a couple of weeks so the gut can adjust. If fibre increases gas and bloating, slow down rather than push through. Drinking enough water helps fibre keep stool soft, and some women need a gentle stool softener or osmotic laxative to pass stool without straining.
Soft, formed stool passes through the exit with less pushing, so less of it gets caught in the bulge. Very hard stool tends to get stuck, while very loose stool can be hard to control, so the goal is in between. Avoiding long periods of straining also protects the supporting tissue from further stress.
Physical therapy comes next if muscles don’t relax properly. Biofeedback teaches you to relax the pelvic floor while pushing, using a sensor and screen. In people with stubborn bloating and difficult emptying, about half who completed it improved, with bloating cut by half.20PubMed. Pelvic floor biofeedback is an effective treatment for severe bloating in disorders of gut-brain interaction with outlet dysfunction Older research found it unhelpful for constipation in general, so it works best when muscle coordination is the problem.21PubMed. Prospective study of biofeedback for treatment of constipation
Sessions start with a therapist assessing muscle strength and relaxation. You practise breathing and pushing techniques, usually over several sessions across weeks, and home exercises keep the gains going.
Surgery can repair the weak wall between the rectum and vagina, and it is usually considered when the bulge is large and other steps fail. A year after repair, bowel symptoms dropped overall, but about 1 in 4 women still needed to splint and over 1 in 3 still strained.22PubMed Central. Changes in bowel symptoms 1 year after rectocele repair
Before surgery, ask whether muscle coordination has been tested first, and what results to expect for bloating specifically. Ask about recovery time and how to avoid straining afterwards.
When Bloating Needs Prompt Attention
- Blood in the stool or black stools
- Unexplained weight loss
- Not passing stool or gas at all, with belly pain or vomiting
- A new change in bowel habits after age 45 to 50
- A bulge that won’t go back in or bleeds
These signs can point to problems other than a rectocele, and colon screening may be due for your age. A bowel blockage with belly pain, vomiting, and no stool or gas passing needs emergency care that day rather than a routine appointment.
Blood in the stool, black stools, or unexplained weight loss call for a prompt appointment, since a rectocele doesn’t explain them. A bulge that can’t be pushed back in or is bleeding should be seen soon, because tissue that stays out can become injured.