About Rectocele Prolapse
Several factors can contribute to the development of rectocele prolapse, including:
- Pregnancy and childbirth: Pregnancy and delivery are major factors in the development of rectocele prolapse. It is more likely to occur if the baby was large, if labor was prolonged, or if there was a multiple birth (e.g., twins). The risk increases with the number of vaginal deliveries a woman has had.
- Age: By the age of 50, around half of all women have some symptoms of pelvic organ prolapse, including rectocele. By the age of 80, over 1 in every 10 women will have had surgery for prolapse.
- Weakening of pelvic support structures: The underlying cause of rectocele prolapse is a weakening of the pelvic support structures and the rectovaginal septum, which is the tissue layer that separates the vagina from the rectum.
Non-modifiable risk factors are factors that cannot be changed or controlled. These include:
- Age: Older age is a non-modifiable risk factor for rectocele prolapse.
- White race: White race has been identified as a non-modifiable risk factor for rectocele prolapse.
- Menopause: Menopause is also considered a non-modifiable risk factor for rectocele prolapse.
- Previous pelvic surgeries: Previous pelvic surgeries increase the risk of developing rectocele prolapse.
Modifiable risk factors are factors that can be influenced or changed. These include:
- Obesity: Being overweight or obese is a modifiable risk factor for rectocele prolapse. Specifically, having a body weight over 90 kilograms or a BMI over 30 kilograms per square meter increases the risk.
- Vaginal delivery and parity: The number of vaginal deliveries and parity (the number of pregnancies carried to viable gestational age) are modifiable risk factors for rectocele prolapse.
- Smoking: Smoking is another modifiable risk factor associated with an increased risk of developing rectocele prolapse.
- Socioeconomic level: Low social and economic levels have been identified as modifiable risk factors for rectocele prolapse.
The symptoms of rectocele prolapse can vary depending on the severity of the condition. Here are the most common early symptoms of rectocele prolapse:
- Vaginal or vulvar irritation
- Feeling of fullness or pressure in the pelvic and vaginal area
- Aching discomfort in the pelvic area
As rectocele prolapse progresses or becomes more severe, additional symptoms may occur:
- Urinary problems, such as stress incontinence (leaking urine when coughing, sneezing, or exercising), being unable to empty the bladder completely, and frequent urination
- Painful intercourse
- Bulging of organs out of the vaginal or urethral opening
In more severe cases, where the rectocele is classified as second-degree or third-degree prolapse, the symptoms may include:
- Constipation
- Difficulty controlling bowel movements
- Bright red blood coming out of the rectum
- Rectal pressure and discomfort
- Mucous discharge
It's important to note that some individuals with mild or minor rectocele prolapse may not experience any symptoms at all. However, as the condition progresses, it's essential to seek medical attention for proper diagnosis and treatment options.
To diagnose rectocele prolapse, doctors commonly perform the following examinations, tests, and procedures:
- Medical history and symptoms: Doctors will ask about your medical history and have you describe your symptoms.
- Physical examination: Your doctor will examine your vagina and rectum to assess the presence and extent of rectocele prolapse. They may observe your rectum and may also place a gloved finger in your anus to check the health or strength of the anal sphincter and rectum.
- Imaging tests: If a doctor finds something unusual during the physical examination, they may recommend imaging tests to further evaluate the condition. These tests can include:
- Defecography or proctography: This is a special type of X-ray that shows the rectum and anal canal during a bowel movement. It helps determine the size of the rectocele.
- MRI (Magnetic Resonance Imaging): This imaging test uses powerful magnets and radio waves to create detailed images of the pelvic area. It can help identify possible causes of the problem.
Additional examinations, tests, and procedures may be performed to determine the stage or severity of rectocele prolapse:
- Anorectal manometry: This involves placing a pressure-measuring tube inside the rectum to check how well the muscles that control bowel movements are working.
- Anal electromyography (EMG): This test measures how effective the muscles and nerves in your rectum are. Electrodes are placed a few inches into your rectum, and responses to pressure are measured.
- Barium enema: This test involves filling the colon with a liquid contrast material called barium, which helps visualize abnormalities in the colon and rectum.
- Vaginal examination: In some cases, a digital vaginal examination may be performed to assess mesh-related complications or determine the extent of vaginal prolapse.
It's important to remember that these examinations, tests, and procedures are conducted by healthcare professionals to accurately diagnose and evaluate rectocele prolapse.
The goals of treatment for rectocele prolapse are to restore the anatomy and physiology, improve continence, improve bowel function, and reduce the incidence of recurrence with lower morbidity and mortality. Here are the different types of treatments and how they work to achieve these goals:
Medication Types:
- Oral or rectal drugs: These medications can help soften the stool and relieve constipation, which is often associated with rectocele prolapse. They work by promoting regular bowel movements and preventing stool from becoming hard and difficult to pass.
Therapies:
- Pelvic floor muscle training: This therapy involves exercises that strengthen the muscles in the pelvic floor, including the muscles around the rectum. By strengthening these muscles, it can help improve continence and bowel function.
Therapeutic Procedures:
- Transanal rectocele repair (TAR): This procedure involves repairing the rectocele through the anus. It aims to restore the anatomy by strengthening the supportive wall between the rectum and vagina. TAR can help improve bowel function and reduce symptoms associated with rectocele prolapse.
- Posterior colporrhaphy: This procedure is a transvaginal repair technique that involves suturing the weakened tissue in the posterior vaginal wall. It aims to restore the anatomy by providing support to the rectum and reducing the bulging of tissue into the vagina.
- Laparoscopic transabdominal approach: This minimally invasive surgical approach involves repairing the rectocele through small incisions in the abdomen. It aims to restore anatomy by strengthening the supportive wall between the rectum and vagina. The laparoscopic approach offers advantages such as faster recovery, less blood loss, and less pain medication.
Self-care and Health Behavior Changes:
- Changes in diet: Making dietary changes such as increasing fiber intake and staying hydrated can help prevent constipation and improve bowel function. Consuming a balanced diet rich in fruits, vegetables, whole grains, and drinking plenty of water can soften stools and promote regular bowel movements.
- Keeping stool soft: Avoiding straining during bowel movements is important to prevent worsening of rectocele prolapse symptoms. Keeping stools soft through adequate fiber intake and hydration can help reduce strain during defecation.
These various treatment options aim to address different aspects of rectocele prolapse, including restoring anatomy, improving continence, relieving constipation, and reducing symptoms. The choice of treatment depends on individual factors such as symptom severity, patient preference, and healthcare provider's recommendation.
Over time, without treatment, rectocele prolapse can progress and lead to various complications. Here is an overview of the natural progression, common complications, and the impact of treatment for rectocele prolapse:
Natural Progression
- Rectocele prolapse can worsen over time if left untreated.
- The supporting ligaments and muscles in the pelvic floor weaken, causing the rectum to protrude further into the vagina.
- As the condition progresses, symptoms such as difficulty controlling bowel movements, constipation, rectal pressure and discomfort, and mucous discharge may become more pronounced.
- In severe cases, a large rectocele can cause tissue to protrude through the vaginal opening.
Common Complications
- Ulcers: Rectocele prolapse can lead to ulcers in the rectum, causing bleeding and pain.
- Damage to the sphincter: The ring-shaped muscle that controls the opening and closing of the anus (sphincter) may be affected if it is damaged by rectocele prolapse.
- Bowel control issues: Rectocele prolapse can result in problems with bowel control, leading to fecal incontinence.
- Gangrene: If left untreated, rectocele prolapse can cause strangulation of the rectum, cutting off its blood supply. This can lead to tissue death (gangrene), which is a medical emergency requiring surgery.
In some cases, a small rectocele can be managed at home with these lifestyle changes. However, severe cases may require surgical intervention to repair or strengthen the pelvic support structures and rectovaginal septum. Surgery can help alleviate symptoms, slow down or stop the progression of rectocele prolapse, and reduce the risk of complications like ulcers and gangrene
It's important to note that each individual's experience with rectocele prolapse may vary. Consulting with a healthcare professional is crucial for an accurate diagnosis, personalized treatment plan, and appropriate management of this condition. They can provide guidance on suitable treatment options based on individual circumstances.