Feels like a strange bubble in the vagina? Let's talk about Rectocele!

As women, we often have health issues that are a little difficult or embarrassing to talk about. The topic we are going to talk about today may be one of those. Do you sometimes feel a strange heaviness, fullness, or a bubble-like feeling coming out of your vagina? Do you feel like your stomach hasn't completely emptied after going to the toilet? Then this article will be very important for you. Don't be afraid, let's talk about this openly.

Simply put, what is Rectocele?

Okay, let's put this very simply. Rectocele is a condition where the muscles and tissue between your rectum (the end of your large intestine) and your vagina become weak, causing part of your rectum to protrude through the back wall of your vagina. It's like a weak spot in the wall between two rooms and it bulges out. This is also called a posterior vaginal wall prolapse.

Normally, the muscles in our pelvic floor hold our organs like the uterus, bladder, vagina, and rectum in place. It's like a net holding these organs up. Over time, when these muscles weaken due to things like childbirth, these organs start to drop down and fall on top of each other. This condition is commonly called Pelvic Organ Prolapse (POP) . Rectocele is one type of POP condition.

This is not a life-threatening disease. However, it can be a major inconvenience and annoyance in daily life. But the best thing is that there is an effective treatment for this.

What symptoms might you experience with a rectocele?

Not everyone gets symptoms. Sometimes you may not feel any discomfort even if you have this condition. But if symptoms do occur, they are more of an inconvenience and a nuisance than a pain.

Check the table below to see if you have these characteristics.

If you have one or more of these symptoms, it's best to not be shy and meet with your family doctor or a gynecologist to talk about it.

Why is this happening? What are the factors that influence it?

The main reason for this is the weakening of the pelvic floor muscles that we discussed earlier. There are several reasons why these muscles can become weak.

• Multiple pregnancies and childbirth: Having multiple children, especially more than five, can weaken the pelvic floor muscles. This is one reason why these conditions were common in the days of our mothers and grandmothers.
• Vaginal delivery: There is a greater risk of damage or weakness to these muscles when the baby is delivered vaginally. This is especially true if forceps or vacuum were used to deliver the baby, if the vagina was torn, or if an episiotomy (cut between the vagina and anus) was performed.
• Aging: Like all muscles in our body, these muscles naturally weaken as we age. Hormonal changes after menopause can also cause these muscles to lose their firmness.
• Obesity: As you gain weight, the extra weight puts a lot of pressure on your pelvic floor muscles, which can weaken them.
• Chronic constipation: Constant straining to pass stool puts excessive pressure on the pelvic floor muscles. Straining over time is a major cause of weakening these muscles.

In addition to these main causes, having a condition like chronic cough or bronchitis, or regularly lifting weights can also increase this risk.

How does the doctor know if this is the case?

A gynecologist can usually diagnose this condition by asking about your symptoms and performing a physical examination.

• Pelvic exam: The doctor will examine your vagina to see if there is any prolapse. They may also test the strength of your pelvic muscles.
• Telling the muscles to tighten: You can tighten the pelvic muscles, as if you were stopping the flow of urine, and then tell them to relax again.
• Asking to be pushed: You can ask to be pushed by applying pressure to the stomach as if you are having a bowel movement. This will make the lowering more visible.

After this examination, your doctor may give you a `stage` or `grade` depending on the severity of your Rectocele.

Very rarely, you may be asked to have a transvaginal ultrasound to check for a prolapsed small intestine (enterocele). You may also be advised to have a special X-ray or MRI test called defecography to look for changes in your rectum during bowel movements.

What are the treatments for this?

Treatment for this depends on the severity of your symptoms. Non-surgical treatments are usually tried first.

Nonsurgical management

• Pelvic floor exercises: These are what we call Kegels . These exercises can help strengthen weakened muscles. It is best to learn exactly how to do these exercises from a physiotherapist who has received special training in this area.
• Preventing constipation: It is very important to reduce constipation. To do this, your doctor will tell you to eat more fiber-rich foods (beans, greens, broccoli, bananas, brown rice) and drink plenty of water throughout the day. He may also recommend a stool softener.
• Vaginal Pessary: ​​This is a removable device that can be inserted into the vagina. It provides support to the lower limbs. There are different types of `pessaries` that you can insert and remove as needed.

Surgery

If the simple treatments above don't help your symptoms, or if your low back pain is severe, surgery is the next option. Your doctor will discuss the following with you before deciding which surgery is right for you:

• Your age and overall health.
• The severity of the decline.
• Are you expecting more children in the future?
• Whether you want to continue having sex through the vagina (because some surgeries, such as `colpocleisis`, close the vagina).

The most common surgery for rectocele is posterior colporrhaphy . In this procedure, the surgeon removes damaged, weakened tissue and stitches healthy tissue together. This creates a new, stronger support. Because this surgery is often performed through the vagina, there is no visible scar.

Important questions to ask your doctor

When you visit the doctor, you may find it helpful to ask the following questions:

• What lifestyle changes do I need to make to reduce my symptoms?
• How can I prevent this Rectocele condition from getting worse?
• What can I do to prevent other pelvic organ prolapse?
• Would you recommend surgery for me? If so, what are the risks?
• What is the success rate of the type of surgery you recommend?
• Will this treatment affect my sex life or ability to get pregnant?

A few more questions that many people have

What happens if left untreated?

If left untreated and without lifestyle changes, Rectocele can worsen over time. Symptoms can worsen and affect daily life even more.

Can this be prevented from happening?

It may not be possible to completely prevent it. But there are many things you can do to reduce your risk. Doing Kegel exercises regularly, avoiding constipation (eating fiber-rich foods and drinking plenty of water), and controlling your weight are the best things you can do.

Can stool get stuck inside a rectocele?

Yes, it is possible. If the prolapse is severe, the stool can get stuck inside the pouch that has formed. Then the stool will not come out easily.

This is when you need to "splint" (tighten with your finger). If you do this, it is very important to wash your hands thoroughly with soap and water before inserting your finger into the vagina. Otherwise, you can get germs. If you have to defecate this way, be sure to talk to your doctor about it and seek treatment.

Is a Rectocele a Hernia?

This is similar to a hernia. That is, the rectum protrudes into the vagina (herniates). However, medically, Rectocele is not classified as a hernia, but as a type of pelvic organ prolapse.

It's normal to feel embarrassed and ashamed about this condition. But remember, you're not alone. There are good treatments for this. All you need to do is talk to a doctor about it. Many people can manage it with physical therapy and lifestyle changes. If the condition is severe, surgery can be a complete cure.

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