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. Rectoceles can also occur posteriorly or laterally. Rectocele 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 defecation with excessive straining
- perineal and vaginal pressure and bulging
- intermittent fecal 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.
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