Rectocele

A rectocele is an abnormal bulging of the rectovaginal septum (which is normally a semi-rigid divider between the rectum and vagina ) into the vaginal area. It occurs when the end of the large intestine (rectum) pushes through the back wall of the vagina. A rectocele usually results from prior damage to the fascia that causes it to weaken, such as during childbirth or from excessive straining. It can be caused by many factors, but the most common is childbirth, especially a difficult birth which involves a vaginal tear or episiotomy, or the use of forceps. Pelvic surgeons who treat rectocele must have an excellent understanding of the normal anatomy, interactions of the connective tissue and muscular supports of the pelvis, and the relationship between anatomy and function. Mild (small) rectoceles may cause no signs or symptoms. More severe (large) rectoceles may cause a noticeable bulge of tissue through the vaginal opening. Most rectoceles occur in women where the front wall of the rectum is up against the back wall of the vagina. This area is called the rectovaginal septum and may be a weak area in the female anatomy. Other structures may also push into the vagina. A rectocele or an enterocele can be present at birth (congenital), though this is rare.

Rectocele is defined as herniation or bulging of the posterior vaginal wall, with the anterior wall of the rectum in direct apposition to the vaginal epithelium. A rectocele or an enterocele may become large or more obvious when you strain or bear down. Because rectocele and enterocele are defects of the pelvic supporting tissue and not the bowel wall, they are treated most successfully with surgery that repairs the vaginal wall. Surgical repair of rectoceles and enteroceles is used to manage symptoms such as bulging (prolapse) of the intestine into or out of the vagina, low back pain, and painful intercourse. Rectocele and enterocele formation may occur together, especially if you have had surgery to remove the uterus. A rectocele may be present without any other abnormalities. A rectocele should only be treated if it causes significant symptoms. Milder cases can be treated by measures such as management of constipation, Kegel exercises to strengthen the pelvic floor and the insertion of a vaginal pessary to prop up the pelvic organs. In severe cases, surgery is useful.

Causes of Rectocele

The common causes and risk factor's of Rectocele include the following:

• Childbirth.
• Use of forceps during delivery.
• Chronic constipation, a chronic cough, a lot of heavy lifting, and obesity.
• Bowel or rectal injury.
• Infection.
• A weakening of the pelvic support structures and thinning of the rectovaginal septum.
• Bladder injury.
• An episiotomy into the rectum or anal sphincter muscles.
• Forceps or other assisted methods of delivery.
• Perineal tears.

Symptoms of Rectocele

Some sign and symptoms related to Rectocele are as follows:

• A feeling that the rectum has not completely emptied after a bowel movement.
• Bulging vaginal mass.
• Constipation or difficult bowel movements (rectocele only).
• A sensation of rectal pressure.
• Pain or discomfort during sexual intercourse.
• Pelvic pressure in the rectal area.
• Lower back pain.
• Vaginal bleeding that's not related to the menstrual cycle.

Treatment of Rectocele

Here is list of the methods for treating Rectocele:

• Rectocele is not a dangerous condition and generally requires no treatment.
• A bowel management program is the best first step.
• In general, you should avoid constipation by eating a high fiber diet and drinking plenty of fluids.
• Rest in bed (with the foot of the bed elevated) and wet packs applied to the vagina will reduce edema.
• A vaginal pessary is a plastic or rubber ring that's inserted in the vagina to support the bulging tissues.
• Rectoceles are also treated by surgery.

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