A posterior repair is used to treat rectocele, which is a herniation or bulge of the front wall of the rectum into the back wall of the vagina. The tissue between the rectum and the vagina is known as the rectovaginal septum, and this structure can become thin and weak over time, resulting in a rectocele. If a rectocele is small, most women won’t have any symptoms. A rectocele may be an isolated finding or occur as part of a generalized weakening of the pelvic floor muscles. Other pelvic organs such as the bladder (cystocele) and the small intestine (enterocele) can bulge into the vagina, leading to similar symptoms as rectocele.
Cause
The exact cause of this phenomenon is unknown, but symptomatic rectoceles usually occur in conjunction with the weakening of the pelvic floor. There are many things that can lead to the weakening of the pelvic floor, including advanced age, multiple vaginal deliveries, and birthing trauma during vaginal delivery. In addition, a history of chronic constipation and excessive straining with bowel movements are thought to play a contributory role in developing a rectocele. Multiple gynecological or rectal surgeries can also lead to the weakening of the pelvic floor and rectocele formation.
Symptoms
Approximately 40 percent of all women will have a rectocele found on routine physical examination. When symptoms are present, they may be categorized as either rectal or vaginal. Rectal symptoms may include difficulty with evacuation during a bowel movement and the need to press against the back wall of the vagina and/or space between the rectum and the vagina in order to have a bowel movement. Vaginal symptoms can include the sensation of a bulge or fullness in the vagina, tissue protruding out of the vagina, discomfort with sexual intercourse, and vaginal bleeding.
Diagnosis
Examination of the pelvic region typically includes both a vaginal and rectal examination. This often includes a bimanual and speculum examination. In addition, a digital rectal exam will be performed which usually demonstrates a weakness in the anterior wall of the rectum (which is the side closest to the vagina). A special x-ray, called defecography, can also visualize and confirm a rectocele.
Treatment
A rectocele should only be treated if you are having significant symptoms that interfere with your quality of life. Prior to any treatment, there should be a thorough evaluation by your doctor. There are both medical and surgical treatment options for rectoceles. The majority of symptoms associated can be resolved with medical management; however, the treatment depends on the severity of symptoms.
Non-Surgical Treatment
The vast majority of a patient’s symptoms associated with a rectocele can be managed effectively without surgery. It is very important to have a good bowel regimen in order to avoid constipation and straining with bowel movements. A high fiber diet of 25+ grams per day can help with this goal and can be achieved with a fiber supplement, high fiber cereal, or high fiber bars. In addition to this, you should also increase your water intake; the average recommendation is six to eight ten-ounce glasses daily. Another way to lessen the symptoms of a rectocele is through biofeedback, which refers to exercises you perform with a provider to strengthen and retrain the pelvic floor.
Surgical Treatment
If you continue to have symptoms of rectoceles despite the use of conservative methods like the ones mentioned above, surgical management may be necessary. These symptoms should be significant enough that they interfere with your activities of daily living, meaning that you cannot comfortably do the things that you usually do on a daily basis. Doctors Miklos and Moore are experts in the diagnosis and treatment of rectoceles and will be able to provide the relief you desire.
The overall success of the surgery for rectocele depends on the symptoms, length of time the symptoms have been present, and the approach of surgery. As with any surgical procedure, there are associated risks, including bleeding, infection, new-onset dyspareunia (pain during intercourse), incontinence, rectovaginal fistula, and a risk that the symptoms may recur or worsen.
Despite being one of the most common operations in the field of gynecology, it is probably one of the most poorly understood. The rate of success is 80 percent after one year and 60 percent after three years. Fortunately, this is also one of the least invasive surgeries that gynecologic surgeons perform. Doctors Miklos and Moore will use augmentation grafts to reinforce the posterior repair if the patient has failed at least two previous surgeries and at the patient’s request.