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Evaluating for presence of rectocele
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Evaluating for presence of rectocele

I've not sought medical advice for a rectocele even though I've had issues for a few years.  But, recently my "bulge"  has gotten larger when I need to have a BM and I've been experiencing rectal and even sacral discomfort when I cannot get my bowels to move easily.  If I am able to evacuate then the bulge disappears even if I feel like I did not evacuate completely.  Make sense?  I'm not prone to constipation but sexual activity and, weirdly enough, travel can leave me unable to have a BM for many days.

Since the obvious sign (the bulge) is apparent when I need to have a BM, I'm wondering how a rectocele gets a proper diagnosis. I'm not going to try to "hold it in" before my appointment.  I've read that some women have defograms and I've also read responses from women with diagnosed rectoceles who have never had any sort of imaging procedure.

Is a physical (vaginal and rectal) exam enough to give a physician an idea about what is going on?

I just emailed a women's pelvic clinic (urogyn and physical therapy is their strength) yesterday expecting that I could get an appointment as a new patient sometime this summer but they actually just called and said that I could come in tomorrow.  So I'm hoping that anyone with experience could share how their diagnosis came to be so that I can feel a little more prepared for what to expect.  

Past history includes laparoscopically assisted vaginal hyst with ovaries removed in 2005, minor bladder prolapse noted post-op (I do have moderate urinary incontinence), no longer taking replacement hormones for around 4 years with subsequent atrophic vaginitis.
Tags: rectocele
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Do you know if you had the top of your vaginal vault suspended when you had your hysterectomy done?  
A diagnosis for rectocele is best done as a standing examination where you are asked to bear down in order to show the extent of your prolapse/s.  However, a lot of Urogynecologists do a laying down examination with you bearing down as well.  You could ask to stand up to do this if you want to though.  
It is true that POPs in general fluctuate in degree depending on what time of the day it is ( worse at the end of the day or before a Bowel Movement etc).   However, it is important to get a diagnosis in order to find out what treatment options are available to you.

It is great to hear you can go to the women's pelvic clinic and see a Urogyne and a PT as well.  Get your notes from your operation in 2005 as well, even if you dont have them until after you appt, you can give them in when you get them as this could tell the Urogyne if you had any vaginal vault support done all those years ago.  

All your symptoms of bulging and rectocele are familiar to me.  I also have POPs and one of them is a rectocele.  With no support, exercise with womens PT, or operation POPs do tend to get worse over time anyway and this could be the right time for you to adress this.  Getting good womens PT is also very important whether you have POP or not, and whether you have an operation or not to keep your pelvic floor as strong as possible.  
Have you considered a pessary?  I use a silicone pessary that supports my recotocele and bladder side and is very helpful.

Good luck and let us know how you get on.
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Sorry I didn't respond sooner.  Yes, I did have a McCall's culdoplasty as part of my hysterectomy.

I went to the appt and a simple vaginal physical exam showed that I had a stage 2 rectocele.  I just had to bear down and cough for it to be seen. My pelvic floor muscle strength is good but the vaginal tissue itself is not healthy and I also have an issue with some fascia that connects (rather it should connect but doesn't anymore) to my pubic bone area.  I do remember an injury occurring around 15 years ago but I did not think it would affect my pelvic organs.  

She wasn't confident that PT would help in my instance but that if we couldn't find some relief that I'm more than welcome to try.  She set me up with some compounded estrogen vaginal cream for the atrophy.  And, she said that I should take my magnesium supplement every day to avoid any constipation that will make things worse.  I usually only took that after constipation was an issue.  

We did not discuss a pessary.  Hopefully the doctor's assessment of my situation is correct and avoiding constipation will help with pain/discomfort and will stop the progression along with the use of the vaginal estrogen.  Here's to hoping!

Thanks for getting back to me.  I will keep your advice in mind if this worsens.
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I am glad you are now using vaginal estrogen cream as this will help to plump up your vaginal skin and keep it health.  I use this and it really helps.
Its a bit disappointing but not surprising that your Dr didnt promote the use of a pessary or PT as they often know very little about the large amount of pessaries available.  If you decide you want to try a pessary look at the different ones available and get measured up by your Urogyne.
Is your Dr a Urogynecologist?  They are the prolapse specialists and the best ones to see for prolapses.
If you change you mind and feel you need more support for your rectocele you can always try a pessary.  
As far as PT is concerned, we all need a strong pelvic floor whether we have no prolapses, prolapses, or have had a prolapse operation, so womens PT is a good idea.  
Ask to be referred if you wish to try womens PT.  
Avoiding constipation is very important.  If magnesium isnt effective enough then go back and try a different laxative.  I use Laxido/Miralax, and this has helped me a lot.
You can improve evacuation of BM by elevating your legs ( put your feet up on a stool etc ) to unkink the last part of the colon.  Some people buy a sqatty potty, but I simply use a stool.  The MOOOing technique of evacuation without strain by Michelle Kenway ( a PT from Australia ) is a good technique that is also taught in the bowel hospital I go to.  Michelle Kenway is easy to find on the web.  Do some searching for her and also enter emptying bowel without straining on your search.  

Am glad you are making progress.  Come back if you want to ask any more questions at any time.  
Good luck
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