Anorectal: Rectocele

Rectocele

Definition

  • Weakness of the Pelvic Floor Causing Anterior Rectal Bulging
  • Associated with Other Pelvic Organ Prolapse Diseases Such as Rectal, Uterine or Bladder Prolapse
  • Often Confused for Hemorrhoids

Risk Factors

  • Female, Rare in Males
    • Enlarged Genital Hiatus Between Pubic Symphysis & Levator Muscles
    • Vagina & Rectum Share a Common Muscular Wall/Septum
  • Elderly
  • Prior Pregnancy with Vaginal Delivery
  • Chronic Strain
  • Chronic Constipation/Diarrhea
  • Obesity

Symptoms

  • Physical Prolapse
  • Rectal Pain/Pressure
  • Constipation – Stool Can Become Trapped in the Rectocele
    • Severe Cases May Require “Splinting” – Place Fingers into Vagina to Reduce the Rectocele to Facilitate Bowel Movements

Diagnosis

  • Primarily Diagnosed by Physical Exam
  • If Unsure: MRI or Video Defecography

Treatment

  • Asymptomatic/Mild Symptoms: Dietary & Lifestyle Modifications
    • Daily Fiber & Increased Liquid Intake
    • May Consider Biofeedback (Pelvic Floor Physical Therapy)
  • Severe Symptoms: Surgical Repair
    • Can Be Done Through a Transanal or Transvaginal Approach

Rectocele 1

Rectocele Defecography 2

References

  1. Mbpippen. Wikimedia Commons. (License: CC BY-SA-4.0)
  2. Kumar S, Sharma P, Andreisek G. Does conventional defecography has a role to play in evaluation of evacuatory disorders in Indian population? Indian J Radiol Imaging. 2013 Jan;23(1):92-6. (License: CC BY-NC-SA-3.0)