What is Rectocele ?
Rectocele is prolapse of the rectovaginal septum. The rectovaginal septum is a thick, tough and fibrous sheet that separates the rectum and the vagina in women. In other words, rectocele can be explained as a bulge of the rectum wall that protrudes out of the vagina. This happens when levator muscles, Para rectal muscles and prerectal muscle becomes lax.
The swelling of the rectum wall might increase during bowel movement. Rectocele makes the rectovaginal wall weak and thin.
How is Rectocele graded?
Rectocele is graded according to the degree of its inclination into the vagina of women. The grade 1 refers to a small rectocele while the grade 3 rectocele is large and sloppy. Women suffering from grade 3 can have the rectum bulging out of the vagina. This condition can be very painful and uncomfortable for a lady.
The three grades of Rectocele are outlined below:
GRADE 1 Rectocele = this is the mild stage of rectocele, little bulge can be observed.
GRADE 2 Rectocele = at this stage, the bulge sags down to the vaginal opening.
GRADE 3 Rectocele = at this stage, the rectocele bulges out of the vaginal opening.
Picture : Rectocele (Difference between normal female pelvic anatomy and Rectal Prolapse)
Image source : Empowher
Symptoms Of Rectocele
Many women out there has rectocele but are unaware of it as they experience none of its symptoms. If rectovaginal septum bulges 2 centimeter or 1 inch out into the vagina, then the women is experiencing grade 1 rectocele. However, rectocele of grade 3 can cause serious issues for the women suffering from it. Some of them are mentioned below:
- Rectum tissues protrude out of the vaginal opening.
- Pain during the bowel movements.
- The patient experiences difficulty in passing out the stool as it pushes the stool into Rectocele instead of passing it out through the anus.
- The rectum is not fully emptied after bowel movements.
- A rectal pressure is always felt by the patient.
- Pain in the rectum.
- A lower back pain is experienced by some of the women. This pain, however, becomes more severe during the evening.
- Sensation of loose vaginal muscles and sexual concerns increases.
Rectocele can be caused due to many factors. One of such factor is child birth, mainly due to the children who are over 9 pounds or due to rapid birth. The risk of rectocele increases with the number of births. However, it can also occur in women who have never given birth to a child.
The vaginal injury might be caused due to the use of forceps. The lower vaginal tear mostly causes Rectocele rather than, cystocele. The other causes are chronic constipation or heavy lifting or laborious work.
Treatment for Rectocele
Measure for control of Rectocele
The chronic respiratory, correction of constipation, metabolic disorders should be diagnosed. The intra abdominal disorders might increase to the intra-abdominal pressure therefore, it should be vigilantly treated. The patient should be counseled about the positive effects of weight loss, proper diet, the nutrition required and about cessation of smoking.
The backbreaking works should be avoided. The women should be encouraged and motivated to perform exercises which strengthen the pelvic diaphragm. The exercises which include the levator muscle exercises and Kegel exercises are recommended to be performed by the young ladies immediately after childbirth for muscles relaxation. The women are expected to perform the exercise at least 75 times a day. These exercises help get relieve some of the minor symptoms.
Use Of Pessaries
Despite the muscle strengthening exercises, the other non surgical methods to support or treat the prolapse of the recto-vaginal wall is to fit pessaries in the vagina of the patient. Pessaries are a device placed in the vagina to support the drooping rectum. These are available in different sizes and shapes for the convenience of the patient. They work by pressing against the wall of the vagina and the rectum and are retained in the vagina by the vaginal tissues.
There are cases in which the pessary does not retain and falls out due to the dilation of the vaginal tissues. For such patients perineorrhaphy is performed which constricts the vaginal opening thereby, preventing the pessary from falling out. However, these pessaries should be removed on regular bases to avoid the formation of cancer or ulcer. It may cause vaginal irritation therefore the pessary should be cleaned and reinserted periodically.
Surgery or repair of Rectocele
If the rectocele is of grade 3 and it protrudes out of the vaginal opening then the patient must definitely go for surgery. The large rectocele is repaired by surgery and it pushes up the rectum to its correct position. This method is inpatient that is the patient would have to stay in the hospital for a few days, under the care of doctor. There are two ways by which the surgery can be performed.
Firstly, by using general anesthesia and secondly, by using regional anesthesia. In general anesthesia, the patient is asleep during the surgery while, in regional anesthesia, the pelvic region is numb and the patient is awake. However, many techniques have been developed for the surgical treatment of rectocele like defect-directed repair, posterior colporrhaphy, transanal repair, posterior fasical replacement and abdominal approaches.
The surgery is performed through the vagina. For this, the back wall of the vagina is opened and the fasica between the vagina and the rectum is toughened. This is done either by using sutures or by the use of synthetic mesh.
The complications that might occur due to the surgery are:
The anesthesia used can make the patient feel nausea; blood passes out with urine, headache, cut lips or vomiting. With general anesthesia the risks are of heart attack and strokes. Blood may clot in the legs of the patient, a few days after the surgery were done. This causes pain in the leg.
Bleeding can continue after or during the surgery. In this case blood transfusion would become necessary. In some cases, the nerves in the reproductive system are effected which may cause sexual dysfunction.