A rectocele can be treated by several types of specialists depending on your symptoms and how severe the prolapse is. Gynecologists, urogynecologists, colorectal surgeons, and urologists all play roles in diagnosis and treatment. For many women, though, the first step is nonsurgical care from a primary care provider or pelvic floor physical therapist.
Where to Start: Your Primary Care Provider
Most people first mention rectocele symptoms to their OB-GYN or primary care doctor. These providers can perform a physical exam, often using a grading system that measures how far the rectal wall has bulged into the vagina. The most common grading scales range from Grade 0 (normal position) to Grade 4 (maximum descent). This initial assessment determines whether you need conservative management, a specialist referral, or both.
If the prolapse is mild and your symptoms are manageable, your primary provider may handle treatment directly with lifestyle changes, a pessary (a removable device inserted into the vagina to support the bulging tissue), or a referral to pelvic floor physical therapy. More significant prolapse, bowel symptoms, or difficulty emptying your bladder typically warrants a specialist.
Urogynecologists and Gynecologists
A urogynecologist is often the go-to specialist for rectocele because they focus specifically on pelvic floor disorders. They handle everything from pessary fitting to surgical repair. Standard gynecologists also diagnose and treat rectoceles, particularly when the prolapse occurs alongside other gynecological issues.
When surgery is needed, gynecologists and urogynecologists typically approach the repair through the vagina (a transvaginal approach). This allows them to address the rectocele and, if needed, repair other areas of prolapse at the same time. Most surgical repairs today use the body’s own tissue rather than synthetic mesh. A large Cochrane review found that while transvaginal mesh lowers prolapse recurrence rates, it comes with higher rates of complications: about 12% of women experienced mesh exposure, and the mesh group was more likely to need repeat surgery overall. Because of this risk profile, mesh has limited use in primary rectocele surgery.
Colorectal Surgeons
When bowel symptoms are the main problem, a colorectal surgeon becomes an important part of the team. Obstructed defecation, the feeling that stool is trapped or that you need to press on the vaginal wall to have a bowel movement, is a hallmark symptom that benefits from colorectal evaluation. These surgeons can determine whether the rectocele itself is causing the bowel trouble or whether another issue, like pelvic floor dysfunction or slow gut motility, is contributing.
Colorectal surgeons may repair the rectocele through the perineum (the tissue between the vagina and anus) or through the anus. Surgical outcomes through the perineal approach show symptom improvement in roughly 73% of patients with the standard technique. Modified approaches have pushed that number higher, with some techniques reporting improvement in over 90% of patients and satisfaction rates above 85%.
Pelvic Floor Physical Therapists
Physical therapists who specialize in pelvic floor rehabilitation treat rectocele nonsurgically and are often involved before or after surgery. Their primary tools are pelvic floor muscle training (Kegel exercises) and biofeedback, which uses sensors to confirm you’re engaging the correct muscles with the right amount of force. This matters because many people perform Kegels incorrectly on their own.
Physical therapy can reduce symptoms enough that some women avoid surgery altogether, especially with lower-grade prolapse. For those who do have surgery, pre- and post-operative pelvic floor therapy improves recovery and long-term outcomes.
When You Need More Than One Specialist
Rectocele rarely exists in isolation. The same weakness in the pelvic floor that causes the rectum to bulge into the vagina often affects the bladder or uterus too. The International Urogynecology Association recommends that all patients with rectocele receive a multidisciplinary evaluation involving a gynecologist, colorectal surgeon, and urologist when symptoms are complex.
Some medical centers have integrated pelvic floor clinics where multiple specialists see you in a single visit. At these centers, a urogynecologist and colorectal surgeon may examine you together, review your imaging together, and jointly recommend a surgical plan. Cleveland Clinic’s multidisciplinary pelvic floor program operates this way, with specialists co-consulting on cases to avoid the situation where one repair inadvertently worsens another area of the pelvic floor. If you have symptoms involving both your bowels and your bladder, or if you have prolapse in more than one area, seeking out this kind of coordinated care can make a real difference in outcomes.
Diagnostic Tests Specialists May Order
Beyond the physical exam, specialists use several tools to plan treatment. Defecography is a specialized imaging test where you empty your bowels while X-ray or MRI captures how the pelvic floor moves in real time. A rectocele larger than 2 cm on defecography is considered abnormal. Dynamic MRI provides detailed visualization of the rectocele and surrounding structures without radiation, making it particularly useful for surgical planning. If you also have urinary symptoms, urodynamic studies can help sort out whether the rectocele is affecting bladder function.
Choosing the Right Specialist for You
Your dominant symptoms are the best guide. If you primarily feel a vaginal bulge, heaviness, or pressure, start with a gynecologist or urogynecologist. If difficulty with bowel movements is your main complaint, a colorectal surgeon should be involved early. If your symptoms span multiple areas, look for a center that offers multidisciplinary pelvic floor care so you don’t end up bouncing between offices with conflicting recommendations.