Rectocele

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Rectocele
Gynecology

In

gynecology, a rectocele (/ˈrɛktəsiːl/ REK-tə-seel) or posterior vaginal wall prolapse results when the rectum bulges (herniates) into the vagina.[1] Two common causes of this defect are childbirth and hysterectomy.[2] Rectocele also tends to occur with other forms of pelvic organ prolapse, such as enterocele, sigmoidocele and cystocele.[1]

Although the term applies most often to this condition in females, males can also develop it. Rectoceles in men are uncommon, and associated with prostatectomy.

Signs and symptoms

Large rectocele.

Mild cases may simply produce a sense of pressure or protrusion within the vagina, and the occasional feeling that the rectum has not been completely emptied after a bowel movement. Moderate cases may involve difficulty passing stool (because the attempt to evacuate pushes the stool into the rectocele instead of out through the anus), discomfort or pain during evacuation or intercourse, constipation, and a general sensation that something is "falling down" or "falling out" within the pelvis. Severe cases may cause vaginal bleeding, intermittent fecal incontinence, or even the prolapse of the bulge through the mouth of the vagina, or rectal prolapse through the anus. Digital evacuation, or, manual pushing, on the posterior wall of the vagina helps to aid in bowel movement in a majority of cases of rectocele. Rectocele can be a cause of symptoms of obstructed defecation.[3]

Causes

Rectoceles result from the weakening of the pelvic floor also called

forceps delivery, and perineal tear.  In addition, a history of chronic constipation and excessive straining with bowel movements are thought to play a role in rectocele.  Multiple gynecological or rectal surgeries can also lead to weakening of the pelvic floor.[2] Births that involve babies over nine pounds in weight, or rapid births can contribute to the development of rectocele.[medical citation needed
]

A hysterectomy or other pelvic surgery can be a cause,[4] as can chronic constipation and straining to pass bowel movements. It is more common in older women than in younger ones; estrogen which helps to keep the pelvic tissues elastic decreases after menopause.[medical citation needed]

Diagnosis

The diagnosis of a rectocele primarily occurs with a physical examination and an interview where symptoms of difficulty defecating are reported.  Women often mention the need to insert a finger in the vagina or use of suppositories and/or enemas to aid in having a bowel movement. They may report that strenuous pushing to defecate causes bleeding and pain.  Surveys about the impact on quality of life may be administered to aid in determining the need for treatment.[5]

A pelvic exam and digital rectal exam are done to evaluate the amount of protrusion and anal sphincter tone.[5] Fluoroscopic defecography (FD), evacuation proctography, or dynamic magnetic resonance imaging (MR defecography, MRD) may be used to evaluate functional and anatomic conditions.[6]

Treatment

Non-surgical

Treatment depends on the severity of the problem, and may include non-surgical methods such as changes in diet (increase in fiber and water intake),

hormone replacement therapy for post-menopausal women and insertion of a pessary into the vagina. Vaginal pessaries can immediately relieve prolapse and prolapse-related symptoms.[7] A high fiber diet, consisting of 25–30 grams of fiber daily, as well as increased water intake (typically 6–8 glasses daily), help to avoid constipation and straining with bowel movements, and can relieve symptoms of rectocele.[8][9]

Surgical

Surgery can be done to correct rectocele when symptoms continue despite the use of non-surgical management, and are significant enough to interfere with activities of daily living.[8]

Surgery to correct the rectocele may involve the reattachment of the muscles that previously supported the pelvic floor.

gynecologists and colorectal surgeons can address this problem.[8] Potential complications of surgical correction of a rectocele include bleeding, infection, dyspareunia (pain during intercourse), as well as recurrence or even worsening of the rectocele symptoms.[8] The use of synthetic or biologic grafts has been questioned.[10][11]

References

  1. ^
    S2CID 801534
    .
  2. ^ a b "The Pathophysiology, Diagnosis, and Management of Rectoceles | GLOWM". www.glowm.com. Retrieved 2017-12-27.
  3. ISBN 978-1-84882-755-4
    .
  4. ^ "Rectocele: Risk factors - MayoClinic.com". Retrieved 2007-11-21.
  5. ^
    S2CID 231712416
    .
  6. S2CID 254562051
    .
  7. ISSN 0002-9378
    .
  8. ^ a b c d e Rectocele Archived 2015-02-10 at the Wayback Machine, by Jennifer Speranza, MD at American Society of Colorectal Surgeons. Reviewed 2012
  9. ^ "Cystoceles, Urethroceles, Enteroceles, and Rectoceles – Gynecology and Obstetrics – Merck Manuals Professional Edition". Merck Manuals Professional Edition. Retrieved 2017-12-28.
  10. ABIM Foundation
    , American Urogynecologic Society, retrieved June 1, 2015, which cites:
  11. PMID 27901278
    .

External links
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