When to worry about a vaginal bulge with rectocele

A rectocele occurs when the tissue between the rectum and vagina becomes less supportive, allowing the rectum to press forward. This may cause vaginal pressure or a bulge, especially during a bowel movement. You might also have constipation, incomplete emptying, or a need to press gently on the vaginal wall to help stool pass. These symptoms can overlap with other pelvic-floor problems, so an examination is needed to identify the cause.

Arrange a routine review if the bulge is persistent or bowel symptoms are interfering with daily life. Avoid repeated straining, allow enough time on the toilet, and ask whether fluids, fibre, or a stool-softening plan is appropriate for you. Pelvic-floor physiotherapy may improve coordination and support. Keep a brief record of stool consistency, pressure, pain, and whether the bulge changes after lying down. Do not forcefully press on a painful bulge.

Seek urgent care for severe or worsening pelvic pain, heavy vaginal or rectal bleeding, fever, vomiting, a swollen or discoloured protruding bulge, or inability to pass stool or gas. Contact a clinician promptly for blood mixed with stool, new loss of bowel control, persistent rectal pressure, or symptoms that are rapidly changing. These features may require assessment for obstruction, injury, or another bowel problem.

Ask whether the rectocele is affecting bowel emptying, whether pelvic-floor therapy or a pessary could help, and how to prevent straining. Mention constipation, stool trapping, bleeding, pain, childbirth history, and any need to support the vaginal wall during bowel movements.