The supportive layer of the posterior vaginal wall is called the rectovaginal septum or rectovaginal fascia. It is attached distally to the perineal body, laterally to the levator ani muscle and proximally to the cervix (if uterus is present). When a break in the rectovaginal septum is present the rectal wall will come into contact with the vaginal skin and create a bulge on the posterior bottom side of the vagina. The bulge will usually increase in size with bearing down (Valsalva maneuver) especially when having a bowel movement. Patients with a rectocele may experience:
Vaginal pressure/discomfort
Protrusion coming from the posterior vaginal wall
Difficulty evacuating rectum
Dyspareunia (painful intercourse)
Repositioning of body during bowel movements
Prolapse Relaxation Figure: 1
Normal Vagina Support (side view) - The support structure of the posterior vaginal wall is the rectovaginal fascia. Note the continuous nature of the rectovaginal fascia and its flat appearance.
Prolapse Relaxation Figure: 2
Rectocele (side view) - Note the break in the support structure known as the rectovaginal fascia. A break in the rectovaginal fascia allows the rectal wall to push directly against the vaginal epithelium (skin), thus creating a bulge or a rectocele.
