Managing Mild Rectocele, Cystocele & Constipation: Why Surgery Is Usually Not the First Step
Hearing that you have a mild rectocele, mild cystocele, or pelvic floor dysfunction* can be worrying, especially if you’re struggling with constipation. Many people immediately think surgery is the only solution. Fortunately, that’s usually not the case.
In many patients, the main problem is not the small bulge itself, but the way the pelvic floor muscles work during bowel movements. Normally, these muscles should relax to allow stool to pass. In some people, they tighten instead of relaxing—a condition called “dyssynergic defecation”. This makes it difficult to empty the bowel completely, leading to excessive straining, a feeling of incomplete evacuation, and chronic constipation.
To understand the exact cause of your symptoms, your doctor will ask about your bowel habits, stool consistency, the need for straining or using your fingers to help empty the bowel, and any urinary symptoms such as leakage or difficulty passing urine. A history of pregnancy, pelvic surgery, or menopause may also be relevant. Tests such as “anorectal manometry” and “defecography” can help determine whether constipation is mainly due to poor muscle coordination or pelvic organ prolapse.
The first step in treatment is improving bowel function. Soft stools are much easier to pass and reduce pressure on the pelvic floor. Drinking adequate water, eating enough soluble fibre such as psyllium, staying physically active, and using an osmotic laxative like polyethylene glycol (PEG) when necessary can make bowel movements much more comfortable.
One of the most effective treatments for pelvic floor dyssynergia is *biofeedback therapy. During a series of supervised sessions, a trained therapist teaches you how to relax the pelvic floor muscles while coordinating abdominal pushing during bowel movements. This retrains the muscles to work normally. Studies have shown that nearly **70–80% of patients experience significant improvement* with properly performed biofeedback therapy, making it the preferred treatment for this condition.
Simple changes in toilet habits can also make a noticeable difference. Sitting with your feet supported on a small stool, leaning slightly forward, avoiding prolonged sitting on the toilet, and responding promptly to the urge to pass stool can all improve bowel emptying while reducing unnecessary straining.
Pelvic floor physiotherapy may also be recommended, especially when rectocele and cystocele occur together. Treatment focuses on improving muscle coordination, breathing techniques, and relaxation exercises. It’s important to remember that “Kegel exercises are not suitable for everyone”. In patients whose pelvic floor muscles are already too tight, strengthening exercises without proper guidance may actually worsen constipation.
Surgery is rarely the first choice for a mild rectocele. It is usually considered only when the prolapse is causing significant symptoms, conservative treatment has failed, or quality of life is seriously affected. Treating pelvic floor dysfunction before considering surgery often leads to better long-term results.
Take-home message
If you’ve been diagnosed with a mild rectocele, mild cystocele, and constipation, don’t panic. In most cases, the symptoms can be managed successfully with biofeedback therapy, bowel habit modification, pelvic floor physiotherapy, and healthy lifestyle changes. Addressing the underlying muscle dysfunction—not just the anatomical bulge—helps most patients achieve lasting relief without the need for surgery.
For More information Meet Our Best Gastroenterologist Dr. Vatsal Mehta.