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It is the prolapse of the large intestine loops due to relaxed connective tissue. Rectocele is the protrusion of the bowel loops through the back wall of the vagina.
It appears as a pink bulge when viewed externally. Vaginal hernia or bowel hernia is staged in 4 degrees. Grade 1 represents a mild hernia, which becomes noticeable when straining or lifting heavy loads while standing. In grade 4 vaginal hernia, the bowel loops completely protrude outside the vagina even in a lying position.
Rectocele in the vagina is the protrusion of bowel loops through the vaginal mucosa, which is the inner lining. The bowel loops are not directly visible but can be felt by hand under the mucosa. Rectocele is often accompanied by vaginal widening.
Rectocele, or large bowel herniation, may include the small bowel in some untreated cases. In this situation, it may lead to intestinal obstruction, ileus, and require emergency medical intervention. Almost all vaginal hernias involving the small intestine require treatment and surgical intervention. If these hernias are left untreated, they can result in death.
The connective tissue and muscle structure of the vagina prevent the internal abdominal organs from protruding through the vaginal opening. However, particularly in women who have had vaginal births, tears in the connective tissue and muscles can lead to rectocele.
Having been pregnant, even if the cervix has dilated up to 4 cm without vaginal delivery, is often sufficient to cause vaginal hernia. In other words, even without a vaginal delivery, experiencing labor pains or carrying a baby can be enough to cause vaginal hernia or rectocele. Additionally, rectocele is more common in:
After the reproductive period, mothers often have to lift heavy loads while taking care of their children. The incidence of rectocele increases after conditions such as large baby pregnancies, whether the delivery is vaginal or cesarean.
During normal vaginal birth, the baby's passage through the birth canal creates defects in the vaginal wall's connective tissue and muscle. These defects are more pronounced in women who have not done exercises before childbirth.
If an anatomical tear has occurred, the rectocele may progress over the years to stage 4, where a bulging mass is visible even when lying down. The perineal body, located between the anus and vagina, serves as the peak point where all vaginal and pelvic muscles meet, providing structural support.
If there is collapse or shortening in the 2-3 cm structure of the perineal body between the anus and vaginal opening due to childbirth, rectocele becomes more pronounced. If perineal body collapse exists, repair of the muscles and connective tissue in this area is essential during rectocele surgery, otherwise, the recurrence of rectocele is inevitable.
Even if patients with rectocele do not experience a bulging mass, they may have various symptoms. In stage 1 rectocele, a bulging mass may not be noticeable when at rest. However, bowel loops may protrude during straining, heavy lifting, or during sexual intercourse. In stages 2 and beyond, bowel loops may protrude even when lying down. In addition to the bulging mass seen in the vagina, rectocele patients often experience the following symptoms:
Rectocele during pregnancy is usually observed in the 2nd or 3rd pregnancy. In the first pregnancy, the presence of trauma in the vaginal structure is required. Rectocele and hemorrhoid symptoms tend to increase after the 24th week of pregnancy. It does not have any negative effects on the pregnancy or fetus.
The presence of rectocele does not prevent normal delivery. However, in cases of severe herniation (stage 3 and 4),bowel herniation can impair blood flow to the bowel during the delivery process.
Insufficient blood flow to the bowel can lead to bowel ruptures and severe infections. Therefore, pregnant women with this condition must be examined by an obstetrician before delivery. Another option is to plan for a cesarean delivery.
Bowel hernia is considered the same as rectocele. If there is mild rectocele accompanied by slight vaginal bulging and the patient does not want surgery, vaginal laser therapy can be attempted. However, since the cause of rectocele is anatomical tears, and to avoid recurrence, the definitive treatment is surgery.
The definitive treatment for rectocele is rectocele surgery. An important aspect of rectocele surgery is that removing only the vaginal mucosal tissue is insufficient; the vaginal muscle tissue and perineal body (the area between the anus and the vagina) should also be repaired simultaneously. During rectocele surgery, the herniated bowel sac is removed through the vaginal area, and the opening is closed with absorbable sutures.
Since the vaginal mucosa and muscle structures are repaired, rectocele surgery also tightens the vagina and resolves complaints of vaginal looseness during sexual intercourse. The surgery typically lasts about 1 hour and can be performed under general anesthesia or spinal anesthesia.
After rectocele surgery, there may be mild pain that can be managed with painkillers on the first day. Patients often report less pain than they experienced after childbirth. Patients can take a shower on the second day, and hospitalization typically lasts 1 day.
Return to work and normal life is possible by the third day. However, heavy exercise and lifting heavy loads should be avoided for the first 10 days. Sexual intercourse can generally resume after the 4th week.
Since tight and stiff clothing may put pressure on the stitches and cause discomfort, it is advisable to avoid such clothing during the first 10 days. Additionally, since constipation may cause pain and strain on the stitches, if constipation occurs, it is beneficial to ask your doctor for stool softeners.
After rectocele surgery, a return to normal life can begin by the third day. However, complete tissue healing and resumption of sexual activity typically take about 4 weeks. The stitches used in the surgery are absorbable, which helps strengthen the connective tissue, allowing the vaginal wall to remain strong without requiring stitch removal.
In patients with vaginal hernia, sexual life is negatively affected due to vaginal looseness, disruption of the vaginal structure, and loss of the ability of the mucosal tissue to contract. Problems such as difficulty reaching orgasm, sexual arousal issues, and reduced sensation of the penis due to vaginal looseness negatively impact both the patient and their partner. Additionally, vaginal prolapse may require manual repositioning or cause a visible bulge during intercourse.
In patients who have not undergone rectocele surgery, passing gas or stool during intercourse is common. Rectocele surgery greatly improves sexual confidence and quality of sexual life.
Chronic constipation, prolapsed organs, persistent pelvic pain, and involuntary gas leakage all significantly affect quality of life. Surgical repair of vaginal hernia can greatly improve quality of life.
Rectocele is the herniation of the bowel through the vaginal wall. Since the primary defect is in the vaginal wall, it should be treated by experienced gynecologists.
The cost of vaginal hernia surgery varies depending on the hospital or clinic, whether procedures such as bladder prolapse surgery, perineoplasty, and labioplasty are performed. Price information is typically provided after a consultation.
In rectocele surgery, the vaginal mucosa is not removed alone; the surrounding connective tissue and often the perineal body are also repaired. When performed correctly and carefully, recurrence of rectocele is unlikely. However, if there is excess weight, it should be reduced, and if the patient smokes, they should quit.
Rectocele is the herniation of the bowel through the vaginal wall. If vaginal prolapse is left untreated, it may lead to recurring infections, pain, foul odor, inability to engage in sexual intercourse, impaired blood flow to the herniated bowel, and even severe sepsis (severe infection in the blood). Since vaginal healing is more difficult after menopause, surgery is recommended as soon as rectocele is diagnosed.
After menopause, the connective tissue decreases, and untreated rectocele can worsen, causing the surgical procedure to become more complex. In untreated cases with prolapsed bowel, the bladder and even the uterus may become involved due to abdominal pressure.
Since the genital area is a whole, the following surgeries can be easily performed in the same session as vaginal hernia surgery:
During the examination, the doctor should assess the pelvic floor as a whole, identify defects, and make a surgical plan for complete pelvic floor repair.
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