Rectocele

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A rectocele ( REK -t? -seel ) or vaginal wall prolapse posterior results when the rectum has herniation or forming a bulge in the vagina. Two common causes of this defect are: childbirth, and hysterectomy. Rectocele also tends to occur with other forms of pelvic organ prolapse such as enterocele, sigmoidocele and cystocele.

Although this term most often applies to this condition in women, men can also develop it. Rectoceles in men are rare, and associated with prostatectomy.

Video Rectocele

Symptoms

Mild cases may only produce a sense of pressure or bulge in the vagina, and sometimes the feeling that the rectum has not been completely empty after a bowel movement. Moderate cases may involve difficulty removing the stool (since evacuation attempts to push the stool into the rectocele rather than out through the anus), discomfort or pain during evacuation or intercourse, constipation, and the general sensation that something is "falling down" or "falling out "inside the pelvis. Severe cases can cause vaginal bleeding, intermittent faecal incontinence, or even prolapse of the vaginal discharge, or rectal prolapse through the anus. Digital evacuation, or, pushing manually, on the posterior wall of the vagina helps to assist in bowel movement in most cases of rectocele. Rectocele can be the cause of the stunted bowel symptoms.

Maps Rectocele

Cause

The result of rectoceles from weakening the pelvic floor is also called pelvic organ prolapse. The weakened pelvic structure occurs as a result of episiotomy during previous births, even decades later. Other causes of pelvic floor prolapse are old age, multiple vaginal delivery, and labor trauma. Labor trauma includes vacuum labor, forceps delivery, and perineal rupture. In addition, a history of chronic constipation and excessive tension with bowel movement is thought to play a role in the rectocele. Some gynecological or rectal surgery may also cause weakening of the pelvic floor. Births involving infants weighing more than nine pounds, or rapid births can contribute to the development of rectocele.

Hysterectomy or other pelvic surgery can be a cause, such as chronic constipation and straining to pass through bowel movements. This is more common in women older than younger; estrogen that helps maintain pelvic tissue elasticity decreases after menopause.

Rectocele - Southwest Surgical Associates

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Treatment

Non-surgical

Treatment depends on the severity of the problem, and may include non-surgical methods such as changes in diet (increased fiber and water intake), pelvic floor exercises such as Kegel exercises, use of stool softeners, hormone replacement therapy for post-menopausal women and the insertion of pregnancy-prevention devices into the vagina. A high-fiber diet, consisting of 25-30 grams of fiber daily, as well as an increase in water intake (typically 6-8 glasses daily), helps to avoid constipation and strains with bowel movements, and can relieve rectocele symptoms.

Surgery

Surgery can be performed to correct the rectocele when symptoms continue despite the use of non-surgical management, and significant enough to interfere with daily life activities.

Surgery to repair a rectocele may involve reconnecting muscles that previously support the pelvic floor. Another procedure is posterior colporafi, which involves suturing the vaginal tissues. Surgery may also involve insertion of a support mesh (ie patch). There are also surgical techniques aimed at repairing or strengthening the rectovaginal septum, rather than simple excision or vaginal skin patching that does not provide support. Both gynecologists and colorectal surgeons can solve this problem. Potential complications of rectocele surgical correction include bleeding, infection, dyspareunia (pain during intercourse), as well as recurrence or even worsening of rectocele symptoms. Use of synthetic or biological grafts has been questioned.