“I’ve had constipation all my life but my stool is soft, I eat healthy, and I drink plenty of water. So why is this happening?”
This is a question many women ask and sometimes, the answer isn’t constipation at all.
I’m Dr. Nabila Nur, a board-certified urogynecologist and pelvic reconstructive surgeon. In this article, we’ll explore rectocele, a commonly misunderstood condition that often mimics constipation but has a completely different cause and solution.
What is a Rectocele?
A rectocele (also known as posterior vaginal wall prolapse) occurs when the rectum pushes into the back wall of the vagina due to weakened pelvic floor support.
Your pelvic organs including the bladder, uterus, and rectum are supported by muscles, ligaments, and connective tissue known as the pelvic floor. When these structures weaken, organs can shift out of place and press into the vaginal walls.
In a rectocele:
The rectum bulges forward into the vaginal wall
A “pocket” forms, where stool can get trapped
This prevents normal, complete bowel emptying
Why It Feels Like Constipation
Many women with rectocele believe they are constipated—but here’s the key difference:
Stool consistency is often normal (soft, not hard or pellet-like)
Diet, hydration, and fiber intake may already be adequate
The problem is mechanical, not digestive
Because of the pocket created by the bulge, stool gets trapped and doesn’t pass easily even with straining.
In some cases, women may need to:
Press on the vaginal wall with their fingers
Support the bulge to help stool pass
This is a strong sign that the issue is structural rather than typical constipation.
Common Symptoms of Rectocele
Women with rectocele may experience:
A feeling of bulging or pressure in the vagina
Sensation of incomplete bowel emptying
Need to manually assist bowel movements
Pelvic heaviness or discomfort
Difficulty with intimacy due to pressure or pain
These symptoms can significantly affect daily comfort and quality of life.
What Causes Rectocele?
Rectocele develops when the pelvic floor weakens over time. Common causes include:
1. Pregnancy and Childbirth
Vaginal deliveries can stretch or tear pelvic muscles
Episiotomies or lacerations may contribute to weakness
2. Chronic Straining
Long-term straining (often from misdiagnosed constipation) worsens pelvic support
Can also lead to pelvic floor dysfunction
3. Aging and Menopause
Hormonal changes weaken connective tissue and muscles
4. Chronic Constipation (Co-existing)
Some women may have both constipation and prolapse, compounding symptoms
5. Smoking
Weakens connective tissue and contributes to pelvic floor damage
Why Proper Diagnosis Matters
Misdiagnosing rectocele as simple constipation can lead to:
Excessive straining, worsening prolapse
Overuse of laxatives, leading to diarrhea and loss of control
Development of complications such as:
Hemorrhoids
Anal fissures
Worsening pelvic organ prolapse (including bladder or uterine prolapse)
Getting the correct diagnosis is essential to avoid making symptoms worse.
Treatment Options
The good news: rectocele is treatable, and many women improve with conservative care.
1. Pelvic Floor Physical Therapy
Strengthens pelvic muscles
Improves coordination during bowel movements
Helps reduce symptoms and progression
2. Lifestyle Changes
Addressing contributing factors can make a big difference:
Avoid straining during bowel movements
Maintain a healthy weight
Treat chronic cough or constipation
Quit smoking
3. Pessary Use
A pessary is a soft silicone device inserted into the vagina to support pelvic organs.
Helps reduce the bulge
Can improve bowel emptying
Often a first-line, non-surgical option
Different shapes and sizes are available, and fitting is personalized.
4. Surgery
For more severe or persistent cases, surgery can be highly effective.
Typically performed through the vagina (no abdominal incisions)
Usually takes less than an hour
Often done as same-day surgery
Recovery is gradual, with significant symptom relief
Many patients report a dramatic improvement and sometimes describe their first normal bowel movement post-surgery as “life-changing.”
Rectocele is one of the most overlooked causes of bowel dysfunction in women. If you’ve been doing everything “right” like eating well, hydrating, taking fiber but still struggle with emptying your bowels, your body may be signaling something else.
This is not just constipation, it’s a structural issue that deserves proper evaluation and care.
With the right diagnosis and treatment plan, relief is absolutely possible.
If this resonates with you, consider sharing it. Many women silently struggle with symptoms they don’t fully understand and awareness can be the first step toward real relief.