Rectocele refers to a herniation or bulge of the rectal wall, with the most common type being an anterior rectocele where the bulge is into the posterior vaginal wall in a female patient. Rectocoeles can also occur posteriorly or laterally. Rectocoele is the term most commonly used by colorectal surgeons, and the same entity is referred to as a posterior vaginal prolapse by urogynaecologists.
Typical presenting symptoms include:
- difficult defaecation with excessive straining
- perineal and vaginal pressure and bulging
- intermittent faecal soiling
- requirement to digitate to allow evacuation of stools
Anterior rectocele results from a defect in the integrity of the rectovaginal septum with subsequent herniation of the rectal wall into the vagina and inferiorly into the perineum.
- increasing age
Clinical examination may reveal a rectocele and other pelvic organ prolapses such as a cystocele, and these are usually graded using the POP-Q system. Imaging is used to confirm the diagnosis and to evaluate for co-existing pelvic organ prolapse. Both fluoroscopic and MRI proctography can depict rectoceles.
- 1. Beck DE, Allen NL. Rectocele. Clin Colon Rectal Surg. 2010;23 (02): 90-8. doi:10.1055/s-0030-1254295 - Free text at pubmed - Pubmed citation
- 2. Law YM, Fielding JR. MRI of pelvic floor dysfunction: review. AJR Am J Roentgenol. 2008;191 (6_supplement): S45-53. doi:10.2214/AJR.07.7096 - Pubmed citation
- 3. Delemarre JB, Kruyt RH, Doornbos J et-al. Anterior rectocele: assessment with radiographic defecography, dynamic magnetic resonance imaging, and physical examination. Dis. Colon Rectum. 1994;37 (3): 249-59. Pubmed citation
- 4. Janssen LW, van Dijke CF. Selection criteria for anterior rectal wall repair in symptomatic rectocele and anterior rectal wall prolapse. Dis. Colon Rectum. 1994;37 (11): 1100-7. Pubmed citation
- 5. Cundiff GW, Fenner D. Evaluation and treatment of women with rectocele: focus on associated defecatory and sexual dysfunction. Obstet Gynecol. 2004;104 (6): 1403-21. doi:10.1097/01.AOG.0000147598.50638.15 - Pubmed citation