A rectocele is a type of pelvic organ prolapse characterized by the bulging of the rectum into the back wall of the vagina. This condition occurs when the supportive tissues and muscles between the rectum and vagina weaken, allowing the rectum to protrude into the vaginal space. Rectoceles can cause discomfort, difficulties with bowel movements, and other symptoms that affect a person's quality of life. 

Causes: Several factors contribute to the development of rectocele:

1. Childbirth: The most common cause of rectocele is vaginal childbirth, particularly when the delivery involves prolonged pushing or the use of instruments such as forceps or vacuum extraction. The stretching and weakening of the pelvic floor muscles and connective tissues during childbirth can lead to rectal prolapse later in life.

2. Aging: As women age, the pelvic floor muscles and connective tissues naturally weaken, increasing the risk of rectocele.

3. Chronic Constipation: Chronic constipation and straining during bowel movements can put excessive pressure on the pelvic floor, contributing to the development of rectocele over time.

4. Heavy Lifting: Activities that involve heavy lifting or straining can strain the pelvic floor muscles and increase the risk of rectocele.

5. Connective Tissue Disorders: Rarely, genetic factors or connective tissue disorders can predispose individuals to pelvic organ prolapse, including rectocele.

Symptoms: The symptoms of rectocele can vary in severity and may include:

1. Difficulty Passing Stool: Individuals with rectocele may experience difficulty passing stool or feel as though they cannot completely empty their bowels.

2. Pelvic Pressure or Heaviness: Some individuals may feel a sensation of pelvic pressure or heaviness, especially during bowel movements or when standing for long periods.

3. Visible Bulge: In more severe cases, a bulge or protrusion may be visible at the opening of the vagina, particularly during activities that increase intra-abdominal pressure, such as coughing, sneezing, or straining.

4. Pain or Discomfort: Rectocele can cause pain or discomfort in the pelvic region, particularly during bowel movements or sexual intercourse.

5. Rectal Bleeding: In some cases, rectocele may cause minor rectal bleeding, especially if the protruding rectal tissue becomes irritated or injured during bowel movements.

Diagnosis: Diagnosing rectocele typically involves a combination of medical history, physical examination, and possibly additional tests, including:

1. Pelvic Examination: During a pelvic exam, the healthcare provider may visually assess the pelvic organs for signs of prolapse and evaluate the strength of the pelvic floor muscles.

2. Digital Rectal Examination (DRE): A digital rectal examination may be performed to assess the tone and function of the rectal muscles and to detect any abnormalities, such as rectocele.

3. Defecography: Defecography is a specialized imaging test that evaluates the rectum and surrounding structures during a bowel movement. It can help identify rectocele and assess its severity.

4. Anorectal Manometry: Anorectal manometry measures the pressure and function of the rectum and anal sphincter muscles. It may be performed to evaluate bowel function and assess for conditions such as rectocele.

5. Pelvic Floor Ultrasound: Easy and dynamic for the detection of rectocele.

Treatment: The treatment of rectocele depends on the severity of symptoms, the impact on quality of life, and individual patient factors. Treatment options may include:

1. Pelvic Floor Exercises (Kegel Exercises): Strengthening the pelvic floor muscles through exercises such as Kegels can help improve symptoms and provide support for the pelvic organs.

2. Dietary and Lifestyle Modifications: Making changes to diet and lifestyle, such as increasing fiber intake to prevent constipation, avoiding heavy lifting, and maintaining a healthy weight, may help alleviate symptoms of rectocele.

3. Pelvic Floor Physical Therapy: Pelvic floor physical therapy, including biofeedback and electrical stimulation, may be recommended to help improve pelvic floor muscle function and alleviate symptoms of rectocele.

4. Pessary: A pessary is a removable device inserted into the vagina to provide support for the prolapsed organs. Pessaries come in various shapes and sizes and can be an effective nonsurgical treatment option for some individuals with rectocele.

5. Surgical Repair: In cases where conservative measures are ineffective or symptoms are severe, surgical repair of the rectocele may be recommended. Surgical options include anterior colporrhaphy (repair of the anterior vaginal wall), posterior colporrhaphy (repair of the posterior vaginal wall), or minimally invasive procedures such as robotic-assisted or laparoscopic repair.