Rectocoele refers to a herniation or bulge of the rectal wall, with the most common type being an anterior rectocoele 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.
Anterior rectocoele 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
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
Clinical examination may reveal a rectocoele and other pelvic organ prolapses such as a cystocoele, 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 rectocoeles.
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