Can a Rectocele Cause Frequent UTIs?
Yes, a rectocele can contribute to frequent UTIs, though the relationship is indirect—rectoceles are part of the broader spectrum of pelvic floor dysfunction and structural abnormalities that predispose women to complicated and recurrent urinary tract infections.
The Mechanistic Connection
Rectoceles belong to the category of structural pelvic floor abnormalities that can complicate UTIs. While rectoceles primarily affect the rectovaginal septum, they frequently coexist with other pelvic organ prolapse conditions that directly impact urinary tract function 1.
- Cystoceles (bladder prolapse), bladder diverticula, and fistulae are explicitly recognized as structural abnormalities that make UTIs complicated 1
- High post-void residual urine volumes, particularly common in postmenopausal women with pelvic floor dysfunction, directly contribute to complicated UTIs 1, 2
- Rectoceles commonly occur alongside cystoceles and uterine prolapse as part of generalized pelvic floor weakness, with an estimated prevalence of 30-50% in women over age 50 3, 4
Clinical Evidence Linking Rectoceles to UTIs
The evidence base demonstrates a documented association, though limited:
- In a prospective multicenter trial of 119 patients undergoing STARR procedure for rectocele repair, UTI was specifically listed among the adverse events occurring in 15% of patients 5
- This finding suggests that rectoceles and UTIs share common pathophysiologic mechanisms related to pelvic floor dysfunction
- The underlying pelvic floor dysfunction—impaired pelvic floor relaxation and excessive straining—that causes rectoceles also contributes to urinary retention and incomplete bladder emptying 5
Why Rectoceles Predispose to UTIs
The key mechanism is shared pelvic floor dysfunction rather than direct anatomic compression:
- Rectoceles result from tears or stretching of the rectovaginal fascia, typically associated with age and parturition 6
- This same pelvic floor weakness affects the anterior compartment, leading to cystoceles and voiding dysfunction 1
- Voiding dysfunction of any origin is recognized as a factor that complicates UTIs 1
- High post-void residual volumes create urinary stasis, providing an ideal environment for bacterial growth 1, 2
Clinical Implications for Evaluation
When a patient presents with both rectocele and recurrent UTIs, consider:
- Evaluate for cystocele, high post-void residual volumes, and other structural urinary tract abnormalities 1
- Assess for atrophic vaginitis in postmenopausal women, which independently increases UTI risk 2
- Imaging studies are often required to identify the full spectrum of structural abnormalities in patients with complicated UTIs 1
- Dynamic MRI frequently displays multiple pelvic floor disorders simultaneously 7
Management Approach
Address both the rectocele and urinary symptoms comprehensively:
- Initial management should focus on pelvic floor biofeedback therapy, which addresses the underlying dysfunction for both conditions 5
- For postmenopausal women, vaginal estrogen replacement may help prevent recurrent UTIs 2
- Increasing fluid intake may reduce infection risk in women with recurrent UTIs 2
- Surgical repair of rectocele alone may not resolve UTI issues if concurrent cystocele or voiding dysfunction is not addressed 5, 4
Important Caveats
- The correlation between rectocele size and symptoms is weak—a large rectocele does not necessarily cause more UTIs 5
- Rectoceles are often incidental findings; the UTIs may be primarily driven by coexisting anterior compartment prolapse 4
- Surgical correction of the rectocele does not address the underlying pelvic floor dysfunction, which is the root cause of both conditions 5
- Multidisciplinary evaluation by both colorectal and urogynecologic surgeons is ideal for patients with both rectocele and recurrent UTIs 4