Rectocele

WHAT IS IT?

Rectocele refers to a specific type of POSTERIOR vaginal wall defect where the ANTERIOR portion of the rectum will protrude towards the vagina/vaginal canal. A rectocele falls under the broader category of a pelvic organ prolapse.

Diagram depicting a rectocele (R) which is a defect of the posterior vaginal wall (source)
WHAT CAUSES IT?

Loss of connective tissue and/or muscular support of the pelvic floor is responsible for various types of pelvic organ prolapse (including rectocele). This can occur due to following causes:

  • Birthing trauma
  • Iatrogenic trauma 
  • Chronic constipation/straining during bowel movements 
WHAT IS THE INTIAL PRESENTATION FOR THIS CONDITION?

Patient Issues/Chief Complaints:

  • No symptoms: many cases of rectocele are completely asymptomatic
  • Difficulty moving bowels: patients may need to brace the wall of the vagina to have a bowel movement.
  • Vaginal fullness 
  • Difficult/painful intercourse 

Detection On Medical Workup:

  • Detection during pelvic exam
WHAT ARE IMPORTANT ELEMENTS OF THE MEDICAL HISTORY?

Risk Factors:

History of vaginal delivery, older age, increasing parity, obesity

WHAT ARE IMPORTANT FEATURES OF THE PHYSICAL EXAM?

Pelvic Exam:

  • Anterior rectal wall weakness/prolapse can be appreciated on a digital rectal exam
WHAT IS OUR THRESHOLD FOR DIAGNOSING THIS CONDITION?

A pelvic exam showing anterior rectal wall weakness/prolapse typically is all that is needed for a diagnosis.

HOW DO WE MANAGE A PATIENT WITH THIS DIAGNOSIS?

 

 

 

Page Updated: 01.30.2017