Treatment of rectocele

A rectocele is a bulging of the rectal wall toward the vagina, which occurs due to weakening of the tissues between these organs. Fecal matter may be retained in such a bulge, which makes defecation difficult and causes a feeling of incomplete emptying.

According to the American Society of Colon and Rectal Surgeons, a rectocele may prevent complete emptying of the rectum. At the same time, the severity of symptoms does not always depend on the size of the bulge: minor changes sometimes cause noticeable difficulties during defecation, whereas a larger bulge may cause almost no discomfort to a woman for a long time.

Rectocele is classified according to the direction of the bulging and the severity of anatomical changes. Most often, the anterior form is detected in women, when the rectal wall shifts toward the vagina. The stage is determined by how far the tissues have descended: they remain inside, reach the vaginal opening or extend beyond it.

According to the direction of the bulging, the following types are distinguished:

• anterior rectocele — the most common type, in which the anterior wall of the rectum shifts toward the posterior wall of the vagina;
• posterior rectocele — a rare form in which the posterior wall of the rectum bulges backward due to weakening of the muscles and tissues of the pelvic floor;
• lateral rectocele — the bulging forms on the side due to local weakening of the tissues that support the rectum.

To assess the degree of prolapse, the doctor may use the international POP-Q system. It helps to accurately describe how far the tissues have shifted:

• Stage 0 — there are no signs of prolapse;
• Stage I — the tissues have descended slightly and remain inside the vagina;
• Stage II — the bulging reaches approximately the vaginal opening;
• Stage III — the tissues partially extend beyond the vaginal opening;
• Stage IV — the most pronounced tissue prolapse is observed.

The stage describes the severity of anatomical changes but is not the only criterion for selecting treatment. The doctor also takes into account difficulties with bowel emptying, the duration of symptoms, the condition of the pelvic floor muscles and other features.

The main causes of rectocele are associated with weakening of the pelvic floor muscles and the tissues between the rectum and the vagina. This often occurs after pregnancy and childbirth. The risk increases after several vaginal deliveries, perineal tears, as well as the use of obstetric forceps or vacuum.

Other risk factors include:

• chronic constipation and regular severe straining;
• age-related reduction in the strength and elasticity of tissues;
• prolonged cough;
• constant heavy physical exertion;
• obesity, in which pressure on the pelvic organs increases;
• previous operations in the pelvic area;
• congenital weakness of connective tissue.

Rectocele usually occurs under the influence of several factors. For example, tissues weakened after childbirth may gradually stretch due to constipation, frequent straining or significant physical exertion. The longer increased pressure on the pelvic floor persists, the greater the likelihood of the appearance and enlargement of the bulge.

Similar symptoms also occur with other pelvic floor disorders, so their cause can be determined only after an examination and diagnostics.

The doctors at “Oxford Medical” recommend not postponing the examination even with moderate discomfort. Timely diagnostics make it possible to assess the condition of the pelvic floor and begin treatment before the disorder becomes more pronounced.

Diagnosis of rectocele begins with a consultation with a proctologist. The doctor clarifies the nature and duration of the complaints, the presence of constipation, information about childbirth and previous operations. Then the doctor performs an examination and a digital rectal examination to assess the size of the bulge, the condition of its walls and the tone of the pelvic floor muscles. Usually, this is sufficient to establish a diagnosis of rectocele and determine the degree of the disorder.

If necessary, the following may additionally be prescribed:

• gynecological examination — to assess the posterior wall of the vagina and detect other pelvic floor disorders;
• pelvic MRI — if it is necessary to assess the position of the organs and the condition of the soft tissues in more detail, in particular before planning surgical treatment.

After the examination, the doctor establishes the diagnosis, determines the degree of changes and selects the appropriate treatment method.

Without treatment, rectocele may gradually increase, and bowel emptying disorders may become more pronounced. Due to the retention of fecal matter in the bulge, the symptoms may intensify and increasingly affect quality of life.

Complications after rectocele:

• persistent constipation;
• retention of fecal matter in the bulge;
• leakage of a small amount of stool after defecation;
• enlargement of the bulge and increased pressure in the pelvic area;
• further weakening of the pelvic floor muscles and ligaments.

Against the background of general pelvic floor weakness, rectocele may be combined with prolapse of the uterus, bladder or rectum. Timely consultation with a doctor, normalization of bowel movements and adherence to recommendations for strengthening the pelvic floor muscles help reduce the risk of complications.

Prevention of rectocele is aimed primarily at reducing the load on the pelvic floor and maintaining normal bowel function. It is especially important to monitor this after childbirth, with a tendency to constipation, significant physical exertion or the appearance of the first signs of weakening of the pelvic floor muscles.

Main recommendations:

• treat constipation in a timely manner and maintain regular bowel movements;
• add vegetables, fruits, cereals, whole-grain bread and other fiber-containing foods that help normal bowel function to the diet every day;
• drink a sufficient amount of water;
• maintain a normal body weight;
• do not overload the pelvic floor by frequently lifting heavy objects;
• regularly perform properly selected exercises.

If difficulties with bowel movements, a feeling of pressure in the pelvic area or other characteristic symptoms appear, it is worth consulting a doctor. Early examination helps to detect changes in a timely manner and prevent their further progression.

The cost of rectocele treatment is determined individually and depends on the stage of the disease, the severity of the symptoms and the recommended treatment method. If surgical intervention is indicated, the cost of surgery for rectocele is influenced by its type, method of performance, anesthesia and duration of stay in the inpatient facility.

The price of a consultation with a proctologist can be viewed here. Regarding the cost of the necessary medical services, including surgery for rectocele, the doctor will guide you during the appointment after the examination. To book a consultation with a proctologist at “Oxford Medical,” submit a request through the online appointment form or call the clinic.

The information is for informational purposes and does not replace a consultation with a doctor.

Sources:

• American Society of Colon and Rectal Surgeons
• National Institute for Health and Care Excellence
• American College of Obstetricians and Gynecologists