“Given the sensitive nature of the issue, many women tend to not seek medical help before it becomes very serious, says Dr Santhi, a General Surgeon at Kauvery Hospital Alwarpet, Chennai.
A 42-year-old IT employee had struggled with rectocele for over a decade before finally seeking help. She had passed it off as constipation, and had never imagined it was something more serious.
Rectocele is a condition where the rectum outpouches and bulges into the vagina, leading to various uncomfortable and often distressing symptoms. It occurs due to the weakening of the septum that separates the rectum and vagina, which can be caused by factors such as childbirth, constipation, obesity, and aging.
Women with rectocele often find it difficult to pass stool, experiencing an obstruction that requires more pushing pressure than usual. Despite having the urge to defecate regularly, they may feel incomplete after each attempt, due to accumulation of the feces within the rectocele pouch present as a smooth bulge inside the vaginal cavity, a phenomenon known as stool trapping. This causes a dull aching pain inside vagina after incomplete evacuation, which leads to further discomfort. This persistent discomfort also has a psychological impact n the long term.
Rectocele can be attributed to both non-modifiable and modifiable risk factors. Non-modifiable factors include old age and genetics, which are irreversible. On the other hand, modifiable factors, such as obesity, chronic constipation, and pelvic floor weakness after multiple normal deliveries, can be prevented or treated with lifestyle changes.
During childbirth, particularly when repeated vaginal deliveries, tearing, or episiotomy during delivery, the septum can become damaged, leading to rectocele. Unfortunately, many women ignore the early signs of this condition, mistaking it for common constipation. Over time, they may resort to self-treatment with over-the-counter medications, fiber-rich diets, or alternative medicine, which often fails to address the root cause.
The main symptom of rectocele is persistent constipation. However, unlike typical constipation, patients with rectocele often need to exert excessive pressure to pass stool, yet never achieve a sense of completion. This constant struggle can lead to digital evacuation of feces, where women manually remove feces from the anal canal using a finger, a practice that causes significant embarrassment and psychological distress.
The patient may experience discomfort and pain during intercourse (dyspareunia).
The condition is classified into four grades, ranging from mild bulging (Grade 1) to severe prolapse (Grade 4), where the rectocele protrudes out of the vagina., Rectocele may be associated with anal fissures, hemorrhoids, chronic vaginal pain, and lasting psychological issues.
Diagnosis of rectocele involves imaging studies such as defecography and MRI pelvic floor dynamic studies. If the bulge is less than 2 cm, non-surgical treatments like pelvic floor strengthening exercises, Kegel exercises, and biofeedback lifestyle modifications can lead to full recovery, especially in Grade 1 cases. However, more severe cases may require surgery, such as posterior colporrhaphy ,robotic or laparoscopic ventral mesh rectopexy.
It's important to note that surgical interventions do not guarantee 100% satisfaction, as some patients may experience chronic pelvic pain or mesh erosion post-surgery.
Despite the significant impact on their lives, many women remain unaware of rectocele. Women between the ages of 30 to 50, in particular, need to be educated about this condition. The taboo surrounding rectal and vaginal health often prevents patients from seeking timely medical help, which can lead to unnecessary suffering.
Software advancements have made it easier to study pelvic anatomy, aiding in diagnosis and treatment. However, access to such technology remains uncertain in some regions, including India.
“If you or someone you know is experiencing persistent constipation, especially with feelings of incomplete evacuation, don't hesitate to consult a general surgeon. Rectocele is a manageable condition, and with early detection, treatment can significantly improve one's quality of life.
“Silence should never be an option when it comes to your health,” says Dr Santhi.