Rectocele — a condition many women may not realize they have
“I had a rectocele,” Barbara explains, “which is a condition I’m sure a lot of women have, but they just don’t realize it.”
A rectocele occurs when the wall of the rectum bulges into the back wall of the vagina due to weakened connective tissue and pelvic floor muscles in the rectovaginal septum, which is essentially the barrier between these two structures. This type of pelvic organ prolapse (POP) can develop due to various risk factors, including vaginal delivery, chronic constipation, aging, and obesity.
For Barbara, the symptoms of a rectocele were unmistakable once she recognized them. “Every time I would go to urinate, I would have a bowel movement,” she recalls. This unusual pattern indicated that the posterior vaginal wall weakness was affecting defecation and overall pelvic floor function.
For Barbara, a vibrant 76-year-old woman, managing her overactive bladder with Botox injections was already part of her healthcare routine. But when another issue unexpectedly began affecting her quality of life, she needed specialized expertise. Her journey with Dr. Kuhlmann, whom she affectionately calls “Dr. Paige,” demonstrates how the right surgical treatment can restore comfort and confidence while maintaining an active lifestyle.
Managing multiple pelvic floor concerns
Barbara was already seeing another urologist for her overactive bladder, a separate but related pelvic floor issue. “I get Botox for my overactive bladder symptoms, and to stop me from getting up in the middle of the night to use the bathroom,” she explains. “Before that, I was taking medication that helps control the urge to urinate, but I didn’t want to continue medication if I could avoid it, so I started Botox treatment.”
Her urologist recognized that Barbara’s rectocele required specialized surgical expertise. “My other urologist, who is great, referred me to Dr. Kuhlmann for surgery for the rectocele,” Barbara says. This collaborative approach among healthcare providers ensured Barbara received comprehensive treatment for all her pelvic floor disorders.
Understanding treatment options for rectocele
When Barbara learned about her treatment options, she had clear preferences. While some approaches to symptomatic rectocele include non-surgical treatment like pelvic floor exercises (Kegel exercises), a high fiber diet, stool softeners, physical therapy, or use of a vaginal pessary, Barbara’s condition required surgical repair.
“I was told I needed to strengthen this wall, but I said that if I need to build a new wall, it’s not happening,” Barbara states with a laugh. Because conservative approaches weren’t addressing her symptoms adequately, surgical treatment seemed like the appropriate choice. Common treatment options for rectocele repair include transvaginal approaches (through the vaginal opening) or transanal techniques, with the transvaginal posterior vaginal wall repair being most common. In some cases, it may also be necessary to address other types of POP simultaneously, such as:
- cystocele — front wall prolapse where the bladder drops into the vagina; or
- enterocele — where the small intestine pushes into the vagina.
Dr. Kuhlmann’s thorough approach to surgical management
Dr. Kuhlmann’s approach combined advanced diagnostic imaging with clear communication. “She performed some imaging beforehand, and we could see the issue, and then she fixed it,” Barbara explains. Exams, testing, and imaging are common before surgical treatment. For a vaginal rectocele repair, physical examination, x-ray studies, or defecography may be required to help the doctor and patient understand exactly what needs to be repaired during the procedure.
Surgical repair often involves plication, where folds of tissue are stitched together to reinforce the weakened rectal wall and the rectovaginal septum, restoring the normal anatomy and strength of the posterior vaginal wall. This type of rectocele repair addresses the herniation of the tissue and strengthens the supporting structures to prevent recurrence.
A smooth surgical experience and recovery
Barbara’s experience with the procedure exceeded her expectations. “I was treated as an outpatient. The surgery wasn’t painful, but it was quick, and everyone was wonderful to work with!” she enthuses.
Undergoing this type of minimally invasive surgical treatment means an overnight hospital stay isn’t required; it represents the advances in surgical management of pelvic floor disorders that help patients get back to their normal routines sooner.
“Afterward, the recovery process went well, and I felt very little pain,” Barbara reports. The success rates for rectocele repair are generally high when performed by experienced urogynecologists, and Barbara’s outcome reflects this. “I recovered from the surgery and I’m better than I was before,” she states simply.
Ongoing care and prevention for her pelvic floor
Barbara’s commitment to her pelvic health extends beyond surgery. “I’m now going to do pelvic floor therapy to keep the wall strong,” she explains. Pelvic floor physical therapy that includes targeted pelvic floor exercises helps maintain the strength of pelvic floor muscles and can prevent future dysfunction. Additional management strategies for pelvic floor health include:
- education about avoiding activities that increase abdominal pressure;
- guidance on managing chronic constipation with dietary changes or supplements; and
- techniques to support optimal pelvic health with increased age.
“And I will continue to see Dr. Kuhlmann as needed,” adds Barbara.
An enthusiastic recommendation for Dr. Kuhlmann
Barbara’s endorsement of Dr. Kuhlmann is wholehearted. “It’s a personal choice as to who you want to be your doctor, but I certainly recommend Dr. Paige,” she says warmly. “She’s so smart and understands what you are going through. She’s both a wonderful woman and a great doctor.”
This recommendation carries particular weight coming from someone who already had established relationships with excellent gynecologists and urogynecologists. Barbara’s experience with multiple healthcare providers gave her a basis for comparison, making her praise of Dr. Kuhlmann especially meaningful.
For women experiencing symptoms of rectocele, such as difficulty with bowel movements, pelvic pressure, vaginal bulging, dyspareunia (painful sexual intercourse), or the need to manually support the perineum during defecation, Barbara’s story offers hope: surgical repair can address these quality of life concerns effectively, restoring comfort and normal function.
Why choose Tower Urology for rectocele repair and pelvic floor disorders?
At Tower Urology, our specialists understand that posterior vaginal wall prolapse and other pelvic floor disorders can significantly impact daily life and comfort. Dr. Kuhlmann combines expertise in surgical treatment with a patient-centered approach, taking time to explain conditions through imaging and physical examination while providing compassionate care. Whether you need rectocele repair, treatment for other types of pelvic organ prolapse, or management of related conditions, our team offers comprehensive evaluation and personalized treatment plans tailored to your needs and lifestyle.
We invite you to establish a care plan with Tower Urology. Please make an appointment online or call us at (310) 854-9898.
Tower Urology is a proud affiliate of Cedars-Sinai Medical Center, ranked #1 in California and #2 nationwide by U.S. News & World Report. This partnership reflects our dedication to delivering the highest standard of urologic care alongside the best urologists in Los Angeles. Our years of experience and access to Cedars-Sinai’s world-class facilities ensure that our exceptional and innovative urological care positions Tower Urology as a leader in Southern California.
Tower Urology is conveniently located for patients throughout Southern California and Los Angeles, including Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Burbank, Glendale, and Downtown Los Angeles.
Our services include treatment for rectocele and other types of pelvic organ prolapse, comprehensive women’s health care, and management of pelvic floor disorders.
If you’re experiencing symptoms of rectocele or have other pelvic floor concerns, Tower Urology offers expert evaluation and effective surgical and non-surgical treatment options. Contact us to schedule a consultation.
Frequently asked questions about rectocele and posterior vaginal wall repair
Common symptoms of a rectocele include difficulty with bowel movements, feeling the need to manually support the perineum or vaginal wall during defecation, pelvic pressure, vaginal bulging, and, in some cases, dyspareunia (painful intercourse).
Non-surgical treatment includes pelvic floor exercises, a high fiber diet, stool softeners, and vaginal pessary use. Surgical treatment through rectocele repair (transvaginal plication of the posterior vaginal wall) is recommended when conservative measures fail or symptoms significantly impact quality of life.
Most patients experience a relatively quick recovery from transvaginal rectocele repair. The surgery is often performed as an outpatient procedure with minimal pain, and full healing typically takes between four to six weeks, during which restrictions on heavy lifting, sexual intercourse, and strenuous activity apply.
Pelvic floor physical therapy is often recommended after surgical repair to strengthen pelvic floor muscles, prevent recurrence, and optimize long-term outcomes. A specialized physical therapist can provide targeted pelvic floor exercises and education about managing risk factors like chronic constipation.
Sources:
Rectocele
https://www.health.harvard.edu/a_to_z/rectocele-a-to-z
Surgical repair of rectocele. Comparison of transvaginal and transanal approach and personal technique
https://pubmed.ncbi.nlm.nih.gov/24342163
Rectocele
https://www.ncbi.nlm.nih.gov/books/NBK546689/
