Rectocele


Introduction

The rectocele is the herniation of the front wall of the rectum into the back wall of the vagina in the vaginal lumen due to the weakness of the rectum-vaginal septum that separates the rectum and the vagina. It shows as an endovaginal protrusion that occurs with the straining.

The most common symptoms are: difficulty in having a regular bowel movement, feeling of incomplete emptying, need of removing stool with fingers, perineal feeling of weight, and pain during intercourse.

The main causes are: weakness of the pelvic floor structures, defecatory straining associated with constipation or reduced relaxation of the anal sphincter, obstetric trauma and multiparity.


Treatment

The surgical treatment consists in repairing the weakness through the vagina or by laparoscopic abdominal surgery in case of large rectocele or associated with another pelvic pathology.

Transvaginal repair consists in making an incision in the back wall of the vagina, separating the vagina and rectum, and applying stitches to the redundant rectum.

Laparoscopic surgery is carried out through small wounds in the abdomen through which the pelvis is accessed. The rectum is separated from the vagina until reaching the limit with the anus and the pelvic musculature is visualized. The rectum is stretched upwards to be fixed to the sacrum by using a reinforcing mesh.


Benefits

Rectocele repair makes the tumour or lump that comes out from the vaginal introit disappear and, therefore eliminates the symptoms of heavy feeling, pelvic pressure, and possible discomfort in sexual intercourse. It also allows a satisfactory bowel movement again without laxatives, anal fingering or unusual handling.



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