Surgery Overview

A rectocele occurs when the end of the large intestine (rectum) pushes against and moves the back wall of the vagina. An enterocele (small bowel prolapse) occurs when the small bowel presses against and moves the upper wall of the vagina. Rectoceles and enteroceles may develop if the lower pelvic muscles become damaged by labor, childbirth, or a previous pelvic surgery or if the muscles are weakened by aging. A rectocele or an enterocele can be present at birth (congenital), though this is rare.

A rectocele or an enterocele may become large or more obvious when you strain or bear down (for example, during a bowel movement). A rectocele and an enterocele may occur together.

Because rectocele and enterocele are defects of the pelvic supporting tissue and not the bowel wall, they are treated most successfully with surgery that repairs the vaginal wall. This surgery pulls together the stretched or torn tissue in the area of prolapse. Surgery will also strengthen the wall of the vagina to prevent prolapse from recurring. Unless there is another health problem that would require an abdominal incision, rectoceles and enteroceles are usually repaired through the vagina.

What To Expect

General anesthesia is usually used for repair of a rectocele or enterocele. You may stay in the hospital from 1 to 2 days. Most people can return to their normal activities in about 6 weeks. Avoid strenuous activity for the first 6 weeks. And increase your activity level gradually.

Normal bowel function returns within 2 to 4 weeks. It is important to avoid constipation during this time. Your doctor will give you special bowel care instructions. But it is important to include sources of fiber and adequate fluids in your diet. Try to drink about 6 to 8 glasses of water a day.

Most people are able to resume sexual intercourse in about 6 weeks.

Why It Is Done

Surgical repair of rectoceles and enteroceles is used to help symptoms such as pressure from movement of the intestine that pushes against the wall of the vagina, low back pain, and painful intercourse. An enterocele may not cause symptoms until it is so large that it pushes into the middle of the vaginal canal.

Rectocele and enterocele often occur with other pelvic organ prolapse, so tell your doctor about other symptoms you may be having. If your doctor finds a bladder prolapse (cystocele), urethral prolapse (urethrocele), or uterine prolapse during your pelvic exam, that problem can also be repaired during surgery.

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How Well It Works

Surgery helps improve symptoms for most people. But in some cases, prolapse happens again several years after surgery.

Risks

Risks of rectocele and enterocele repair are uncommon but include:

• Urinary retention.
• Bladder injury.
• Bowel or rectal injury.
• Infection.
• Painful intercourse.
• Formation of an abnormal connection or opening between two organs (fistula).