Rectocele-Enterocele Treatment

Rectocele-enterocele treatment is a treatment process planned according to the patient’s complaints, the degree of prolapse, and its impact on quality of life in cases of prolapse developing toward the posterior wall of the vagina as a result of weakened pelvic floor support. Rectocele is the bulging of the rectum toward the posterior wall of the vagina; enterocele is the prolapse of the small intestine toward the upper or posterior part of the vagina [1].

These two conditions may sometimes occur on their own; however, in many patients, they may appear together with other pelvic organ prolapses such as cystocele, uterine prolapse, or vaginal vault prolapse. The aim of treatment is not only to correct the anatomical appearance, but also to reduce the feeling of pelvic pressure, ease difficulty with bowel movements, control the complaint of vaginal fullness, and improve comfort in daily life.

What Are Rectocele and Enterocele?

Rectocele is a posterior vaginal wall prolapse that occurs when the tissues supporting the posterior wall of the vagina weaken and the rectum bulges into the vagina. Mayo Clinic states that posterior vaginal prolapse develops as a result of weakening or tearing of the tissue between the rectum and the vagina [1].

Enterocele is the descent of the small intestine into the lower pelvis, creating pressure especially on the upper or posterior part of the vagina. RCOG defines the bulging of the rectum toward the posterior vaginal wall as rectocele, and the bulging of the small intestine toward the posterior vaginal wall as enterocele in posterior vaginal wall prolapse [2].

In both conditions, the symptoms felt by the patient may be similar: vaginal fullness, a pulling-down sensation, pelvic pressure, straining during bowel movements, and discomfort during sexual intercourse.

Why Do Rectocele and Enterocele Occur?

The main mechanism in the formation of rectocele and enterocele is the weakening of the pelvic floor muscles and connective tissues over time. Vaginal delivery, aging, decreased tissue elasticity after menopause, excess weight, chronic constipation, constant straining, chronic cough, heavy lifting, and previous pelvic surgeries may accelerate this process.

Factors that may contribute to the development of rectocele and enterocele include:

• History of vaginal delivery or difficult delivery,
• Having had multiple births,
• Weakening of tissues after menopause,
• Chronic constipation and frequent straining,
• Excess weight and increased intra-abdominal pressure,
• Chronic cough,
• Habit of heavy lifting,
• Previous hysterectomy or pelvic floor surgeries,
• Genetic predisposition to connective tissue weakness.

Enterocele may become more prominent especially in patients who have previously undergone hysterectomy or whose vaginal vault support has weakened. In rectocele, constipation, straining during bowel movements, and bowel habits are particularly important in treatment planning.

What Are the Symptoms of Rectocele and Enterocele?

The most important factor that determines the decision for rectocele-enterocele treatment is often the symptoms. Mild prolapses may not cause symptoms. In moderate and advanced prolapses, vaginal fullness, a palpable mass sensation, pelvic pressure, and difficulty with bowel movements may become more noticeable.

Symptoms of rectocele and enterocele include:

• A feeling of fullness or pressure inside the vagina,
• A palpable bulge on the posterior vaginal wall,
• A downward pulling sensation,
• Pelvic discomfort that increases after standing for a long time,
• Straining during bowel movements,
• A feeling of incomplete bowel emptying,
• Constipation and the frequent need to strain,
• Pressure, pain, or discomfort during sexual intercourse,
• A feeling of pressure in the lower back or groin area,
• Accompanying urinary incontinence or difficulty urinating.

Johns Hopkins Medicine states that pelvic floor exercises, bowel training, vaginal pessary, or surgical repair options may be used in rectocele treatment depending on the severity of symptoms [3].

How Are Rectocele and Enterocele Diagnosed?

The diagnosis is usually made through a detailed medical history and gynecological examination. During the examination, the posterior wall of the vagina, pelvic floor support, and other accompanying prolapses are evaluated. The degree of prolapse may be seen more clearly by asking the patient to strain or cough.

While examination alone is sufficient in some patients, additional tests may be required if there is difficulty with bowel movements, urinary problems, a history of previous surgery, or suspicion of multiple prolapses. The treatment plan should not be prepared simply because “there is prolapse,” but according to whether the prolapse causes symptoms.

How Is Rectocele-Enterocele Treatment Planned?

Rectocele-enterocele treatment is planned according to the degree of prolapse, the patient’s complaints, and its impact on quality of life. NHS states that treatment options for pelvic organ prolapse may include pelvic floor physiotherapy, hormone therapy, vaginal pessary, and surgery in severe cases [4].

The following points are considered in the treatment plan:

• Whether the prolapse is mild, moderate, or advanced,
• Whether vaginal fullness and pressure affect daily life,
• The presence of constipation and difficulty with bowel movements,
• Straining habits,
• Whether there is discomfort during sexual intercourse,
• Accompanying problems such as urinary incontinence or cystocele,
• The patient’s desire for surgery or suitability for surgery,
• Previous pelvic surgeries.

Non-Surgical Rectocele-Enterocele Treatment

Non-surgical treatment may be considered as the first step, especially in mild and moderate cases. The aim is to slow the progression of prolapse, reduce pelvic pressure, control constipation, and improve quality of life.

Non-surgical treatment options include:

• Pelvic Floor Exercises: Kegel exercises and pelvic floor physiotherapy may help strengthen the supporting tissues.
• Management of Constipation: A fiber-rich diet, adequate fluid intake, and reducing straining may particularly ease rectocele symptoms.
• Bowel Training: Regulating toilet habits and avoiding unnecessary straining are important.
• Weight Control: Excess weight may increase the load on the pelvic floor.
• Treatment of Chronic Cough: Persistent coughing may worsen prolapse by increasing intra-abdominal pressure.
• Vaginal Pessary: Prolapsed tissues may be mechanically supported with a support device placed inside the vagina.

Mayo Clinic states that a pessary is a non-surgical support method for pelvic organ prolapse and can be applied in different shapes and sizes [5].

When Is Surgery Needed in Rectocele-Enterocele Treatment?

Surgical treatment is generally considered when symptoms are significant, when pelvic floor exercises or a pessary do not provide sufficient relief, and when prolapse seriously affects daily life. Mayo Clinic states that posterior prolapse surgery may be considered when pelvic floor exercises or a pessary cannot adequately control symptoms [6].

Surgical treatment may be considered in the following situations:

• Marked fullness or outward bulging in the vagina,
• Difficulty with bowel movements that impairs quality of life,
• Persistent straining and a feeling of incomplete emptying,
• Significant discomfort during sexual intercourse,
• Insufficient benefit from non-surgical methods,
• Accompanying uterine prolapse, cystocele, or vaginal vault prolapse,
• Pelvic pressure and heaviness that disrupt daily life.

What Is Done During Rectocele-Enterocele Surgery?

The main goal of rectocele surgery is to strengthen the weakened supporting tissue between the vagina and the rectum and reduce the bulging in the posterior vaginal wall. During surgery, loosened tissues may be tightened, supporting tissues may be reinforced with sutures, and excess tissue may be removed if necessary [6].

In enterocele, the surgical approach aims to restore support in the area where the small intestine has prolapsed. The operation may be planned through a vaginal, laparoscopic, or abdominal approach. Which technique is appropriate is determined according to the type of prolapse, other accompanying prolapses, previous surgeries, and the patient’s general health status.

Methods Used in Rectocele-Enterocele Treatment

What Should Be Considered After Surgery?

The recovery process after pelvic floor repair surgeries may vary from person to person. RCOG emphasizes the importance of rest, gradual increase in activity, avoiding constipation, and follow-up appointments during the recovery period after pelvic floor repair surgery [7].

Things to pay attention to after surgery include:

• Not lifting heavy objects for the period recommended by the physician,
• Avoiding constipation and straining,
• Drinking plenty of fluids and eating a fiber-rich diet,
• Waiting for the period recommended by the physician before having sexual intercourse,
• Avoiding environments that may pose a risk of infection, such as pools, Turkish baths, and bathing in a bathtub,
• Not missing follow-up appointments,
• Consulting a physician in cases of fever, foul-smelling discharge, heavy bleeding, severe pain, or inability to urinate.

Does Rectocele-Enterocele Recur After Treatment?

Yes, pelvic organ prolapses may recur over time after treatment. The risk of recurrence is affected by factors such as connective tissue structure, age, menopause, chronic constipation, constant straining, excess weight, chronic cough, and heavy lifting.

To reduce the risk of recurrence, it is important to control constipation, reduce straining, manage weight, treat chronic cough, and continue pelvic floor exercises. Especially in rectocele treatment, maintaining regular bowel habits is important for long-term success.

Rectocele-Enterocele Treatment Prices 2026

Rectocele-enterocele treatment prices may vary depending on the degree of prolapse, whether the treatment is planned as non-surgical or surgical, whether a vaginal pessary is required, the scope of the surgery, the type of anesthesia, hospital conditions, and whether accompanying cystocele, uterine prolapse, or urinary incontinence treatment is present.

The most accurate information about current rectocele-enterocele treatment prices for 2026 can be provided after examination and personal evaluation. This is because each patient’s degree of prolapse, complaints, and treatment needs are different.

 Frequently Asked Questions

References

1. Mayo Clinic. Posterior vaginal prolapse (rectocele) - Symptoms and causes. (https://www.mayoclinic.org/diseases-conditions/rectocele/symptoms-causes/syc-20353414)
2. Royal College of Obstetricians and Gynaecologists (RCOG). Pelvic organ prolapse. (https://www.rcog.org.uk/for-the-public/browse-our-patient-information/pelvic-organ-prolapse/)
3. Johns Hopkins Medicine. Rectocele. (https://www.hopkinsmedicine.org/health/conditions-and-diseases/rectocele)
4. NHS. Pelvic organ prolapse. (https://www.nhs.uk/conditions/pelvic-organ-prolapse/)
5. Mayo Clinic. Pelvic organ prolapse - Diagnosis and treatment. (https://www.mayoclinic.org/diseases-conditions/pelvic-organ-prolapse/diagnosis-treatment/drc-20562951)
6. Mayo Clinic. Posterior vaginal prolapse (rectocele) - Diagnosis and treatment. (https://www.mayoclinic.org/diseases-conditions/rectocele/diagnosis-treatment/drc-20353419)
7. RCOG. Pelvic floor repair operation: recovering well. (https://www.rcog.org.uk/for-the-public/browse-our-patient-information/pelvic-floor-repair-operation-recovering-well/)