A rectocele happens when the wall between the rectum and vagina weakens. The rectum then bulges into the vaginal space. Childbirth is the most common cause, but the changes from menopause play a major role too. These two events — pregnancy and the loss of estrogen — are the primary reasons a rectocele develops over a woman’s lifetime.
How Does Childbirth Lead to a Rectocele?
During vaginal delivery, the baby’s head passes through the pelvic floor muscles. This stretches and sometimes tears the connective tissue that holds the rectum in place. The tissue between the vagina and rectum is called the rectovaginal septum. When it gets damaged, it cannot support the rectum as well as it used to.
Research published in the International Urogynecology Journal found that women who had vaginal deliveries had a significantly higher risk of rectocele compared to women who had only cesarean sections. The risk increases with each vaginal birth. Forceps delivery raises the risk even more because of the extra force placed on the pelvic floor.
Not every woman who gives birth vaginally gets a rectocele. Some women have stronger connective tissue that holds up better. But the damage is cumulative. A single birth may cause minor stretching that does not cause symptoms. Two or three births can add up to a noticeable bulge.
Why Does Menopause Make a Rectocele Worse?
Estrogen keeps the vaginal tissues thick and elastic. It also supports the collagen in the pelvic floor. When estrogen drops sharply during menopause, those tissues thin out and lose their ability to stretch and hold shape. A rectocele that was small and symptom-free before menopause can become larger and more bothersome.
The American College of Obstetricians and Gynecologists notes that pelvic organ prolapse, including rectocele, is most common in women ages 50 to 79. This is not a coincidence. The hormonal shift of menopause is the second major event that can turn a hidden weakness into a real problem.
Some women notice symptoms appearing for the first time after menopause even if they never had trouble after childbirth. The tissue simply gave out once estrogen was no longer supporting it.
What Are the Other Causes of a Rectocele?
Chronic constipation is a major contributor. Straining to pass hard stool puts repeated pressure on the rectovaginal wall. Over years, this pressure can weaken the tissue enough to cause a rectocele. This is true even for women who have never given birth.
Heavy lifting at work or during exercise can also play a role. Women who work in jobs that require lifting heavy objects or who regularly do high-impact exercise may be at higher risk. Obesity adds constant downward pressure on the pelvic floor. Chronic coughing from smoking or lung disease can also push the pelvic floor downward over time.
Hysterectomy is another factor. Removing the uterus changes the support structure in the pelvis. The top of the vagina may no longer have the same anchoring points. This can allow the rectum to push forward more easily.
| Cause | How It Affects the Rectovaginal Wall | How Common It Is |
|---|---|---|
| Vaginal childbirth | Stretches or tears connective tissue | Most common cause |
| Menopause | Thins tissue from estrogen loss | Very common in postmenopausal women |
| Chronic constipation | Repeated straining weakens tissue | Common in all age groups |
| Heavy lifting | Increases intra-abdominal pressure | Moderate |
| Obesity | Constant downward pressure | Increasing with obesity rates |
| Hysterectomy | Changes pelvic support structure | Moderate |
What Symptoms Should You Watch For?
Many women with a rectocele have no symptoms at all. The bulge is small and causes no trouble. When symptoms do appear, they are usually related to bowel movements. You may feel like you cannot fully empty your bowels. Some women need to press on the vaginal wall or on the perineum to help stool pass. This is called splinting.
Other symptoms include a feeling of pressure or fullness in the vagina. Some women feel a bulge or something coming out. This can be uncomfortable during walking or sitting. Sexual intercourse may become painful. Some women also experience fecal incontinence or the urge to have a bowel movement that is hard to control.
A study in the journal Obstetrics & Gynecology found that about 25 percent of women with rectocele reported symptoms that affected their quality of life. The other 75 percent had either no symptoms or mild ones that did not bother them much. This is why many rectoceles are found during a routine pelvic exam rather than because a woman complained about them.
What Does Research on What Causes A Rectocele Childbirth To Menopause Show?
The research is clear that childbirth and menopause are the two biggest factors. A large study from the Women’s Health Initiative followed thousands of postmenopausal women. It found that women who had at least one vaginal birth were twice as likely to have pelvic organ prolapse compared to women who had never given birth vaginally. The same study showed that the risk went up with age, confirming the role of menopause.
Some studies suggest that genetics also play a role. Women whose mothers had pelvic organ prolapse are more likely to develop it themselves. Connective tissue disorders like Ehlers-Danlos syndrome also increase the risk. But these are less common than the childbirth-menopause combination.
Evidence indicates that the type of delivery matters more than people used to think. Prolonged second stage of labor — the pushing phase — is linked to more pelvic floor damage. Episiotomy does not prevent rectocele and may increase the risk of certain types of prolapse. Cesarean section before labor begins offers the most protection, but it is not a practical or recommended strategy for preventing rectocele in most women.
Can You Prevent a Rectocele?
Some things are not in your control. You cannot change whether you had a vaginal birth or when menopause happens. But you can reduce the strain on your pelvic floor. Avoiding constipation is the most effective step. Drink enough water, eat fiber-rich foods, and do not sit on the toilet for long periods straining.
Pelvic floor exercises, often called Kegels, can strengthen the muscles that support the pelvic organs. The evidence for Kegels in preventing rectocele specifically is limited. But they do help with pelvic floor strength overall. A 2018 Cochrane review found that pelvic floor muscle training reduced the risk of prolapse symptoms in women who did the exercises regularly.
- Drink 6 to 8 glasses of water daily to keep stool soft
- Eat 25 to 30 grams of fiber from fruits, vegetables, and whole grains
- Do not push during bowel movements — wait or use a stool softener
- Use a small footstool to elevate your knees above your hips when on the toilet
- Avoid heavy lifting or learn to brace your core properly when you must lift
- Maintain a healthy weight to reduce pressure on the pelvic floor
These steps do not guarantee you will never develop a rectocele. But they lower your risk. And they are good for your overall health regardless.
When Should You See a Doctor?
If you feel a bulge in your vagina or have trouble emptying your bowels, see a gynecologist or a urogynecologist. These specialists can do a pelvic exam and tell you exactly what is going on. They can also grade the rectocele from mild to severe based on how far the bulge extends.
Treatment depends on your symptoms. Many women with mild rectocele need no treatment at all. Lifestyle changes and pelvic floor therapy may be enough. For more bothersome symptoms, a pessary — a device inserted into the vagina to support the bulge — can help. Surgery is an option for severe cases, but it is not always needed.
The National Institute of Diabetes and Digestive and Kidney Diseases reports that about 3 percent of women in the United States will have surgery for pelvic organ prolapse at some point in their lives. That number is relatively low because most women manage their symptoms without surgery.
Frequently Asked Questions
Can a rectocele go away on its own?
No, a rectocele does not heal or go away without treatment. The tissue damage is permanent, though symptoms can improve with lifestyle changes and pelvic floor therapy.
Is a rectocele dangerous?
A rectocele itself is not life-threatening. But it can cause discomfort, bowel problems, and affect quality of life. Severe cases may require medical treatment.
Can I exercise with a rectocele?
Yes, but avoid heavy lifting and high-impact activities that increase abdominal pressure. Low-impact exercises like walking, swimming, and pelvic floor exercises are safe and helpful.
Does a rectocele always need surgery?
No, most rectoceles do not need surgery. Only about 3 percent of women with pelvic organ prolapse end up having surgery. Many manage with lifestyle changes, pelvic floor therapy, or a pessary.
