Rectocele
Encyclopedia
A rectocele 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
.
(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.
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, 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.
exercises such as Kegel exercise
s, use of stool softeners, hormone replacement therapy
for post-menopausal women, insertion of a pessary
into the vagina, and various forms of surgery
(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 surgeon
s can address this problem.
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
and vagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
). Rectal tissue bulges through this tear and into the vagina as a hernia. There are two main causes of this tear: childbirth, and hysterectomy
Hysterectomy
A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...
.
Symptoms of 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 stoolFeces
Feces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...
(because the attempt to evacuate pushes the stool into the rectocele instead of out through the anus
Anus
The anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
), discomfort or pain during evacuation or intercourse, constipation
Constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
, and a general sensation that something is "falling down" or "falling out" within the pelvis
Pelvis
In human anatomy, the pelvis is the lower part of the trunk, between the abdomen and the lower limbs .The pelvis includes several structures:...
. Severe cases may cause vaginal bleeding, intermittent fecal incontinence
Fecal incontinence
Fecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected. Subjects relating to defecation are often socially unacceptable, thus those affected may be beset by feelings of shame and humiliation...
, or even the prolapse
Prolapse
Prolapse literally means "to fall out of place", from the Latin prolabi meaning "to fall out". In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is used for organs protruding through the vagina or the rectum or for the misalignment of the...
of the bulge through the mouth of the vagina, or rectal prolapse
Rectal prolapse
Rectal prolapse normally describes a medical condition wherein the walls of the rectum protrude through the anus and hence become visible outside the body.-Types:There are three chief conditions which come under the title 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.
Causes
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 forcepsForceps
Forceps or forcipes are a handheld, hinged instrument used for grasping and holding objects. Forceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are used to perform a task. The term 'forceps' is used almost exclusively...
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
Hysterectomy
A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...
or other pelvic surgery can be a cause, as can chronic constipation and straining to pass bowel movements. It is more common in older women than in younger ones; estrogen
Estrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
which helps to keep the pelvic tissues elastic decreases after menopause
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
. Another cause which is sometimes overlooked in younger women is sexual abuse
Sexual abuse
Sexual abuse, also referred to as molestation, is the forcing of undesired sexual behavior by one person upon another. When that force is immediate, of short duration, or infrequent, it is called sexual assault. The offender is referred to as a sexual abuser or molester...
during childhood.
Treatment
Treatment depends on the severity of the problem, and may include changes in diet (increase in fiber and water intake), pelvic floorPelvic floor
The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the...
exercises such as Kegel exercise
Kegel exercise
A pelvic floor exercise, more commonly called a Kegel exercise , consists of contracting and relaxing the muscles that form part of the pelvic floor, which are now sometimes colloquially referred to as the "Kegel muscles". Several tools exist to help with these exercises, though many are ineffective...
s, use of stool softeners, hormone replacement therapy
Hormone replacement therapy (menopause)
Hormone replacement therapy is a system of medical treatment for surgically menopausal, perimenopausal and to a lesser extent postmenopausal women...
for post-menopausal women, insertion of a pessary
Pessary
A pessary is a small plastic or silicone medical device which is inserted into the vagina or rectum and held in place by the pelvic floor musculature. - Therapeutic pessaries :...
into the vagina, and various forms of surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
(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 surgeon
Surgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
s can address this problem.