# Rectocele - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Cystocele - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK564303/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GD66.01 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Rectocele - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK546689/ · Rectocele - disease-level clinical article (rectocele-full.txt) - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Rectocele - disease-level clinical article (rectocele-full.txt) ## Treatment metadata - Bowel habit, pelvic floor, pessary, then surgery (Recognition & Referral) ## Complete treatment card ```text RECTOCELE Sources: Cystocele - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK564303/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GD66.01 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Rectocele - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK546689/ · Rectocele - disease-level clinical article (rectocele-full.txt) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Presentation ranges from no symptoms at all to a major effect on daily quality of life. - Reported complaints include pelvic pressure, a bulge felt at the back of the vagina, trouble emptying the bowel fully, constipation, and pain with intercourse. [constipation] - When prolapsed tissue is exposed, the surface can erode and bleed. SIGNS - what you find (2) - A full exam covers vaginal, rectal, and abdominal assessment along with a focused neuro check of pelvic floor muscle tone and strength. - One grading system measures how far the prolapse descends past the hymen while the patient bears down. [genital prolapse] TESTS (5) - The clinical exam is what mainly establishes the diagnosis; labs and imaging usually aren't needed. - Defecography places contrast in the vagina, bladder, and rectum and images the patient by X-ray while defecating to confirm the diagnosis. - A rectocele bigger than 2 cm on defecography counts as abnormal. - Urodynamic testing helps before surgery, particularly to check whether incontinence appears once the prolapse is pushed back into place. - Dynamic MRI is a useful add-on for surgical planning, especially when symptoms outweigh what the exam shows. IF NOT THIS - what else fits (1) - Rectal prolapse, enterocele, and sigmoidocele can look similar and belong on the same differential. Source StatPearls "Rectocele" - disease-level clinical article Status traced to the source above 1. BOWEL HABIT, PELVIC FLOOR, PESSARY, THEN SURGERY (RECOGNITION & REFERRAL)[1st line] Adult Posterior-compartment pelvic organ prolapse. The management is graded by symptoms - how much the patient is troubled is what sets the approach. It starts with bowel habit and the pelvic floor, not a prescription: conservative management opens with changes of behaviour, and a high-fibre diet with more water, enough to ease the constipation and the difficulty passing stool, may by itself be enough to improve quality of life. Fluid intake should reach at least 2 to 3 litres a day, none of it alcoholic or caffeinated. Kegel exercises can be started too, and a pelvic floor physiotherapist supervising them helps. Next is a device: where conservative treatment fails, a vaginal pessary is the following step. Surgery is last, kept for those whose defecatory symptoms are obstructive and troublesome, and who have already failed other treatment. Refer to urogynaecology or colorectal surgery for the pessary fitting and the operation. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Posterior-compartment pelvic organ prolapse. The management is graded by symptoms - how much the patient is troubled is what sets the approach. It starts with bowel habit and the pelvic floor, not a prescription: conservative management opens with changes of behaviour, and a high-fibre diet with more water, enough to ease the constipation and the difficulty passing stool, may by itself be enough to improve quality of life. Fluid intake should reach at least 2 to 3 litres a day, none of it alcoholic or caffeinated. Kegel exercises can be started too, and a pelvic floor physiotherapist supervising them helps. Next is a device: where conservative treatment fails, a vaginal pessary is the following step. Surgery is last, kept for those whose defecatory symptoms are obstructive and troublesome, and who have already failed other treatment. Refer to urogynaecology or colorectal surgery for the pessary fitting and the operation. Caution No drug row appears on this card because this article names no drug at all. Its entire conservative arm is diet, fluid and pelvic floor exercise; its entire active arm is a pessary or an operation. Nothing was left out and nothing is pending. A pessary is fitted, not prescribed, and it has its own follow-up. On the article's account the device holds the pelvic floor defect stable while also dealing with anything else present, a cystocele or a prolapse of another organ; the complications seen most often are vaginal discharge, vaginal bleeding and odour. (Rectocele - StatPearls - NCBI Bookshelf, NBK546689) The standard operation: the article names posterior colporrhaphy by the transvaginal route as the approach traditionally preferred for repairing a rectocele. (Rectocele - StatPearls - NCBI Bookshelf, NBK546689) RED FLAG - A need to digitally splint the vagina or perineum to defecate, faecal incontinence, or ulceration of prolapsed tissue. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)