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Rectocele
What is rectocele?
Rectocele is a pelvic floor condition in women that can be associated with changes in bowel habits, most commonly constipation and excessive straining with bowel movements. It is essentially a type of hernia, where the front wall of the rectum pushes out through the vagina.
What are the risk factors?
Certainly, female gender is a risk. Other risk factors are not well known, although straining with bowel movements may contribute to this condition.
What causes rectocele?
The cause of rectocele is not well understood. Again, straining with bowel movements may play a role.
What are the symptoms?
Symptoms of a rectocele may include straining with bowel movements, a feeling of pelvic pressure and a feeling of incomplete evacuation after a bowel movement. Often, the patient notices tissue pushing out of the vagina during bowel movements.
How is rectocele diagnosed?
The condition can be diagnosed upon physical examination. A classic story of straining and self-digitating with bowel movements is helpful. Other pelvic floor studies, including manometry and defacography, are very useful in confirming the diagnosis and ruling out other conditions, such as enterocele.
What treatments are available?
Non-surgical options, such as in increase in dietary fiber and biofeedback, can be helpful to some people with rectocele. However, surgical intervention is often required to cure the condition, particularly when it is very symptomatic. Surgery usually involves local repair of the hernia, which can be done from the vaginal side (transvaginal repair).
Another procedure, STARR – or double stapled transanal rectal resection – is also available. With the help of two staplers, the STARR procedure consists of a circumferential transanal full-thickness resection of the lower rectum. Preparation for the procedure requires bowel preparation and antibiotics, and the procedure is performed under IV sedation or general anesthesia.
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