Rectocele

Chapter 86 Rectocele



INTRODUCTION



Description: Failure of the normal support mechanisms between the rectum and the vagina results in rectocele—herniation of the posterior vaginal wall and underlying rectum into the vaginal canal and eventually to, and through, the introitus.

Prevalence: Ten percent to 15% of women, 30% to 40% after menopause.

Predominant Age: Postmenopausal.

Genetics: No genetic pattern.


ETIOLOGY AND PATHOGENESIS



Causes: Loss of normal tissue integrity or tissue disruption as a result of trauma (childbirth, obstetric injury, surgery).

Risk Factors: Multiparity, obesity, chronic cough, heavy lifting, intrinsic tissue weakness, or atrophic changes resulting from estrogen loss. Some authors include smoking as a risk factor.


CLINICAL CHARACTERISTICS



Signs and Symptoms



• Bulging of the posterior vaginal wall

• Difficulty passing stool (may require manual splinting of the posterior vaginal wall to have a bowel movement)

• Dyspareunia uncommon but may occur


DIAGNOSTIC APPROACH



Differential Diagnosis



• Enterocele

• Rectovaginal hematoma

• Rectal cancer

• Vaginal inclusion cyst (after obstetric trauma or episiotomy)


Associated Conditions: Stress urinary incontinence, pelvic relaxation, uterine prolapse, other hernias, and vaginal outlet relaxation.


Workup and Evaluation



Laboratory: No evaluation indicated.

Imaging:

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Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Rectocele

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