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A weakness that develops in the wall of tissue that separates the rectum from the vagina, called the rectovaginal wall, causing the rectum to protrude into the vagina. Rectocele, a type of hernia, most commonly appears after menopause. Circumstances that chronically stress the muscles of the perirectal area, such as straining with bowel movements or frequent coughing due to pulmonary conditions, are frequent causes.
Weakening of or damage to the perineal structures during vaginal childbirth may also contribute to rectocele. Many women who have small rectoceles do not have symptoms. Larger rectoceles may produce symptoms that include the sensation of pressure in the vagina, pelvic PAIN, painful vaginal intercourse, and occasionally fecal incontinence.
Treatment options include kegel exercises to strengthen the pelvic and vaginal muscles, weight loss to decrease stress on the pelvic muscles, and the insertion of a pessary, a fitted ring placed in the vagina to support the rectovaginal wall. Pessaries may cause irritation and inflammation, however; and women may find them uncomfortable. Surgery to repair the herniation becomes an option when other treatments fail to correct the problem and symptoms continue.
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