Rectocele


Rectocele

Description, Causes and Risk Factors:

The pelvic organs are supported by the pelvic floor muscles. Structures including ligaments and connective tissue help to keep the pelvic organs tethered in place. In women, the front wall of the rectum is situated behind the rear wall of the vagina.

A rectocele is a bulging of the front wall of the rectum into the back wall of the vagina. Rectoceles are usually due to thinning of the rectovaginal septum (the tissue between the rectum and vagina) and weakening of the pelvic floor muscles. This is a very common defect; however, most women do not have symptoms. There can also be other pelvic organs that bulge into the vagina, leading to similar symptoms as rectocele, including the bladder (i.e., cystocele) and the small intestines (i.e., enterocele).

There are many things that can lead to weakening of the pelvic floor, resulting in a rectocele. These factors include: vaginal deliveries, birthing trauma during vaginal delivery (e.g. forceps delivery, vacuum delivery, tearing with a vaginal delivery, episiotomy during vaginal delivery), history of constipation, history of straining with bowel movements, and history of gynecological (hysterectomy) or rectal surgeries.

The following factors may increase your risk of experiencing a rectocele:

    Genetics. Some women are born with weaker connective tissues in their pelvic area, making them naturally more likely to develop a rectocele. Others are born with stronger connective tissues.

  • Childbirth. If you have vaginally delivered multiple children, you have a higher risk of developing a rectocele. If you've had tears in the tissue between the vaginal opening and anus (perineal tears) and incisions that extend the opening of the vagina (episiotomies) during childbirth, you may also be at higher risk.

  • Aging. Your risk of a rectocele increases as you age because you naturally lose muscle mass, elasticity and nerve function as you grow older, causing muscles to stretch or weaken.

  • Obesity. Although the reasons are not entirely clear, a high body mass index is linked to an increased risk of rectocele. This may be due to the chronic stress that excess body weight places on pelvic floor tissues.

Rectocele is most commonly encountered medical condition in women and rarely in men.

Symptoms:

The symptoms of rectocele may be vaginal, rectal or both, and can include:

    A sensation of pressure within the pelvis.

  • The feeling that something is falling down or falling out within the pelvis.

  • Symptoms are worsened by standing up and eased by lying down.

  • Lower abdominal pain.

  • Lower back pain.

  • A bulging mass felt inside the vagina.

  • Vaginal bleeding that is not related to the menstrual cycle.

  • Painful or impossible vaginal intercourse.

  • Constipation.

  • Problems with passing a bowel motion, since the stool becomes caught in the rectocele.

  • The feeling that the bowel is not completely emptied after passing a motion.

  • Fecal incontinence (sometimes).

Diagnosis:

The evaluation of its severity, and potential relation to constipation symptoms, is hard to assess with physical examination alone.A detailed pelvic exam is mandatory.

Further testing for a rectocele may include the use of a special x-ray study known as defecography (contrast material instilled into the rectum as an enema, followed by live x-ray imaging during a bowel movement). This study is very specific and can evaluate a rectocele's size and ability to completely empty.

Treatment:

It is very important to have a good bowel regimen in order to avoid constipation and straining with bowel movements. A high fiber diet, consisting of 25-30 g of fiber daily, will help with this goal. This may be achieved with a fiber supplement, high fiber cereal, or high fiber bars. In addition to augmenting fiber intake, increased water intake (typically 6-8 glasses daily) is also highly recommended. This will allow for softer stools that do not require significant straining with bowel movements, thereby reducing your risk for having a bulge associated with a rectocele. Other treatments may include pelvic floor exercises such as Kegel exercises (i.e., biofeedback), stool softeners, hormone replacement therapy, and avoidance of straining with bowel movements.

The surgical management of rectocele should only be considered when symptoms continue despite the use of medical management and are significant enough that they interfere with activities of daily living. There are abdominal, rectal, and vaginal surgeries that can be performed for rectoceles. The choice of procedure depends on the size of the rectocele and its associated symptoms. Most surgeries aim to remove the extra tissue that makes up the rectocele and strengthening the wall between the rectum and vagina with surrounding tissue or use of a mesh (i.e., patch). Colorectal surgeons, as well as Gynecologists, are trained in the diagnosis and treatment of this condition.

The surgery can be performed in a number of ways, including:

    Through the vagina.

  • Through the anus.

  • Through the area between the vagina and anus (perineum).

  • Through the abdomen.

  • In some cases, a combination of surgical techniques may be necessary.

Surgical risks:

    Urinary retention.

  • Bladder injury.

  • Bowel or rectal injury.

  • Infection.

  • Painful intercourse.

  • Formation of an abnormal connection or opening between two organs.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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