Definition

A defect of the wall between the rectum and the vagina causing a bulging.

Causes

Childbirth and other trauma to the pelvis are the main causes, but anything that alters stooling can contribute.

Symptoms

The most common symptom is noticing a bulge into the vagina when stooling, which can lead to difficulty with complete evacuate.  Sometime patients find it helpful to place a finger within the vagina to splint and allow for all stool to pass.

Diagnosis and Treatment

Diagnosis is made primarily on physical exam, although anorectal physiology testing (ARPS) and some imaging (including dynamic MRI) can be done to supplement the exam.  Typically pelvic floor physical therapy (PT) can improve symptoms, although surgery is often required for recalcitrant cases.  Both colorectal surgeons as well as gynecologists offer repair, with the decision on which approach to take tailored to the individual.

Visit the American Society of Colon & Rectal Surgeons website for more information