What is a rectocele?
A rectocele is a bulge in the back wall of the vagina. It occurs when the wall between rectum (back passage) and vagina weakens and allows the bowel to bulge into the vagina. The common symptoms from a rectocele include a sensation of lump inside or outside of the vagina. Women with a rectocele may also have difficulty opening their bowels and may have to replace the prolapse with a finger in order to empty themselves.
What is the perineal body?
The perineal body is an area between vagina and rectum where pelvic floor muscle join in the midline. It is essential for the integrity of the pelvic floor. Perineal body often get torn and damaged during vaginal delivery. This leads to widening and gaping of vaginal thus predisposing the woman to prolapse of the uterus, rectum, or even the urinary bladder.
Diagnosis of a rectocele
The diagnosis is made on the basis of symptoms and a vaginal examination in clinic. The integrity of the perineal body and pelvic floor muscle tone is also assessed during the examination.
Treatment of a rectocele
The choice of treatment depends on the nature and extent of the condition, as well as personal factors.
Treatment options range from no treatment for a mild rectocele, to surgery for more severe symptomatic prolapse. If a rectocele is not bothersome, the patient may benefit from pelvic floor muscle training exercise to prevent its worsening. Larger and troublesome rectoceles may require surgery to move and keep vaginal wall in a more normal position.
Repair for an isolated rectocele is called posterior colporrhaphy, performed through the vagina. If there are other associated problems (eg. prolapse higher up in the vagina), a laparoscopic operation through the abdomen may be more appropriate.
Reconstruction of the perineal body is a key component of a successful vaginal prolapse repair and is often performed at the same time as a rectocele repair.
Each patient will be able to discuss the available treatments with us in clinic, and can weigh the option of prolapse repair against the severity of her condition and other available treatments.