Rectocele

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Rectocele
Classification and external resources
WeiblichesBeckenMedian.gif
Sagittal section of the lower part of a female trunk, right segment. (Rectovaginal fascia not labeled, but region is visible.)
ICD-10N81.6
ICD-9618.04
DiseasesDB11189
eMedicinemed/3325
MeSHD020047
 
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Rectocele
Classification and external resources
WeiblichesBeckenMedian.gif
Sagittal section of the lower part of a female trunk, right segment. (Rectovaginal fascia not labeled, but region is visible.)
ICD-10N81.6
ICD-9618.04
DiseasesDB11189
eMedicinemed/3325
MeSHD020047

A rectocele (/ˈrɛktəsl/ REK-tə-seel) results from a tear in the rectovaginal septum (which is normally a tough, fibrous, sheet-like divider between the rectum and vagina). Rectal tissue bulges through this tear and into the vagina as a hernia. There are two main causes of this tear: childbirth, and hysterectomy.

Although the term applies most usually to the phenomenon of rectal herniation into the vagina in females, males may suffer with a condition likewise named. Rectoceles in men are uncommon, and usually the protrusion is backwards rather than forwards, as the prostate gland provides structural support anteriorly in men. Prostatectomy appears to be associated with rectoceles in men.[1]

Symptoms[edit]

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.[2]

Causes[edit]

It can be caused by many factors, but the most common is childbirth, especially with babies over nine pounds in weight, or rapid births. The use of forceps is more likely a marker for the vaginal injury, than a direct cause of the tear. Episiotomy or lower vaginal tears play little role in the formation of a cystocele, but may in rectoceles. The risk increases with the number of vaginal births, although it can also happen in women who have never borne a child.

A hysterectomy or other pelvic surgery can be a cause,[3] 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. Another cause which is sometimes overlooked in younger women is sexual abuse during childhood.[citation needed]

Defecating proctogram of female showing rectocele, a possible cause of obstructed defecation and/or incomplete evactuation

Treatment[edit]

Treatment depends on the severity of the problem, and may include changes in diet (increase in fiber and water intake), pelvic floor exercises such as Kegel exercises, use of stool softeners, hormone replacement therapy for post-menopausal women, insertion of a pessary into the vagina, and various forms of surgery[4] (usually posterior colporrhaphy - the suturing of vaginal tissue). More recent developments in surgery are directed at repairs to the rectovaginal septum, than simple excision or plication of vaginal skin, which provides no support. Both gynecologists and colorectal surgeons can address this problem.

References[edit]

  1. ^ Chen, HH; Iroatulam, A; Alabaz, O; Weiss, EG; Nogueras, JJ; Wexner, SD (December 2001). "Associations of defecography and physiologic findings in male patients with rectocele.". Techniques in coloproctology 5 (3): 157–61. doi:10.1007/s101510100018. PMID 11875683. 
  2. ^ Wexner, edited by Andrew P. Zbar, Steven D. (2010). Coloproctology. New York: Springer. ISBN 978-1-84882-755-4. 
  3. ^ "Rectocele: Risk factors - MayoClinic.com". Retrieved 2007-11-21. 
  4. ^ Paraiso MF, Barber MD, Muir TW, Walters MD (2006). "Rectocele repair: a randomized trial of three surgical techniques including graft augmentation". Am. J. Obstet. Gynecol. 195 (6): 1762–71. doi:10.1016/j.ajog.2006.07.026. PMID 17132479.