A rectocele is a bulge of the front wall of the rectum towards the vagina, through the weakened septum between them. The symptoms are mostly about emptying: stool is held in that pocket, there is a sense of retention and incomplete emptying, and some patients can only empty after pressing on the vaginal wall with their fingers.
It most often follows childbirth - particularly instrumental delivery and perineal injury - as well as years of straining with constipation and the drop in oestrogen after menopause, which weakens connective tissue.
In grades I and II physiotherapy clearly improves symptoms, though it does not restore the anatomy: pelvic floor training improves support, and changing how you empty your bowel takes away the daily load that deepens the bulge. In grade III, and where symptoms make normal life impossible, the decision belongs to a gynaecologist or proctologist - and physiotherapy is then preparation for surgery and care afterwards, because an operation does not change how a patient empties her bowel and lifts.
Therapy
- History and assessment of bowel symptoms
- Functional examination of the pelvic floor
- Individual pelvic floor training
- Learning to empty the bowel without straining
- Learning to protect the pelvic floor when lifting, coughing and exercising
- Work on breathing and abdominal pressure
- A home programme