A rectocele is a form of pelvic organ prolapse that occurs when the supportive tissue wall between the rectum and the vagina weakens, allowing the rectum to bulge forward into the vaginal canal. This anatomical change interferes with daily functions, notably bowel movements, and leads to symptoms like pelvic pressure or incomplete evacuation. While a rectocele will not correct itself, many women can effectively manage symptoms and significantly improve their quality of life through practical, non-surgical strategies. This approach focuses on minimizing strain on the pelvic floor and using supportive measures to restore comfortable function.
Immediate Lifestyle Adjustments
Difficulty with bowel movements is the most common symptom of a rectocele, requiring a focus on preventing constipation and straining. Maintaining a high-fiber diet is foundational, with a recommended daily intake between 30 and 35 grams of fiber from sources like fruits, vegetables, and whole grains. It is equally important to drink plenty of water, aiming for approximately 2 to 3 liters of non-caffeinated, non-alcoholic fluids daily, because fiber without adequate hydration can actually worsen constipation.
Proper positioning during a bowel movement is a powerful adjustment. Using a footstool, such as a “squatty potty,” elevates the knees above the hips, which straightens the anorectal angle. This supported squatting posture relaxes the puborectalis muscle, allowing the rectum to empty more easily and reducing the need to strain. It is also helpful to lean forward slightly and take deep, relaxing breaths, as breath-holding and bearing down significantly increase pressure on the pelvic floor.
The rectocele often creates a physical pocket where stool becomes trapped, leading to incomplete emptying. In these cases, manual splinting can be performed to facilitate evacuation without straining. This technique involves inserting one or two clean fingers or a thumb into the vagina and applying gentle backward pressure toward the rectum and tailbone. This manual support effectively pushes the bulge back into alignment, allowing the stool to pass through the anal canal more directly.
Pelvic Floor Strengthening and Support
Physical interventions improve the overall support system of the pelvis. Pelvic floor muscle training, commonly known as Kegel exercises, helps by increasing muscle tone and mass in the pelvic floor, which offers firmer support to the organs. To perform them correctly, focus on contracting the muscles used to stop urine flow or prevent passing gas, while keeping the abdomen, buttocks, and thighs relaxed. The correct technique involves a gentle squeeze and an inward lift of the muscles surrounding the anus and vagina, as if lifting a marble upward.
A common regimen is three sets of 10 to 15 repetitions daily, holding each contraction for three to ten seconds, followed by an equal period of rest. While Kegels can reduce the severity of symptoms and prevent the prolapse from worsening, they do not typically correct the underlying anatomical defect. Working with a pelvic floor physical therapist ensures the exercises are performed with the right technique and tailored to address any specific muscle weaknesses or overactivity.
For women seeking continuous, non-surgical support, a pessary may be an appropriate option. A pessary is a device, typically made of medical-grade silicone, that is inserted into the vagina to physically hold the pelvic organs in place. Fitted by a healthcare provider, these devices come in various shapes and sizes, offering mechanical support distinct from muscular support. A pessary can immediately relieve the physical feeling of a bulge or heaviness by preventing the rectum from protruding into the vaginal space.
Managing Secondary Physical Discomfort
A rectocele can cause secondary symptoms, such as pelvic heaviness or pressure, often worsened by standing for long periods. To alleviate this discomfort, women can temporarily relieve pressure by lying down and raising their legs, perhaps with a pillow placed under the knees. Lying on one side with the knees drawn toward the chest can also help shift the internal pressure away from the pelvic floor.
Discomfort during sexual intercourse (dyspareunia) may arise due to anatomical changes or associated muscle tension. Employing water-based lubricants can significantly reduce friction and burning, particularly if a reduction in estrogen has led to less natural lubrication. Open communication with a partner is important to find comfortable positions that minimize pressure on the vaginal wall.
Experimenting with different positions allows a couple to find an angle that avoids direct pressure on the prolapse. Positions where the woman controls the depth of penetration are often helpful. Practicing pelvic floor relaxation techniques, which often involve deep diaphragmatic breathing, immediately before and during intimacy can help reduce muscle guarding and tension that contribute to pain. Adequate foreplay also ensures natural arousal and lubrication, which improves comfort.
When Conservative Management Isn’t Enough
While conservative strategies are effective for most women, a consultation with a specialist is necessary when symptoms persist. Persistent symptoms that impact quality of life, such as severe pelvic pain or the inability to have a bowel movement without manual splinting, require further medical evaluation. Any noticeable worsening of the prolapse, where the bulge appears larger or protrudes further from the vaginal opening, also warrants a specialist visit.
Specialists, typically urogynecologists or colorectal surgeons, perform a comprehensive physical assessment to determine the stage and severity of the rectocele. They may suggest advanced non-surgical options, such as biofeedback therapy, which uses electronic sensors to help a woman learn how to control and coordinate her pelvic floor muscles more effectively. If conservative measures have been exhausted and symptoms remain debilitating, the specialist can discuss definitive treatments like surgical repair, which aims to reinforce the weakened wall between the rectum and the vagina.