The pelvic floor is a structure formed by muscle layers hanging like a hammock between the anterior part of the pelvic girdle and the sacrum. These supporting muscle layers called levator ani. They keep bladder, uterus and intestines in place and close the exit of bladder and large bowel. After the levator muscle group becomes weaker, pelvic floor descends and its support for bladder, uterus and bowels decreases. In addition, these organs also shift downwards. All supporting tissues between these organs also become weaker and Pelvic Diseases occurs a result.
Rectocele is one of the most frequent pelvic floor diseases.
Herniation of the last part of the large bowel, rectum, into the vagina. It develops as a result of weakened supporting tissue between rectum and vagina. Rectocele, which actually develops in majority of the women, is only diagnosed after it starts to cause symptoms. Multiple vaginal deliveries, advanced age, uterus surgery history, constipation for years are among main reasons.
The most important complaint is difficulty in defecation. Although this is generally referred as constipation by many patients, the real fundamental problem is the fact that they perform excess strain to defecate and not feel sufficient sensation of complete discharge or relief. Most of the patients have to apply pressure to the vagina in order to dispose the stool.
Palpable mass in the vagina,
Pain during sexual intercourse,
Anus pain and rectal bleeding,
Gas and fecal incontinence,
Feeling of fullness in the anus and vagina.
Rectocele can be diagnosed easily with gynecological and proctological examination. Some tests, such as defecography, are needed to plan the treatment. These tests and examination of other pelvic floor diseases are of crucial importance in terms of the success of the treatment.
Method of rectocele treatment is decided based on the size of the rectocele and severity of the complaints. Dietary treatment and muscle exercises (Kegel exercises) are the first recommended treatment methods.
Surgical treatment is considered in large rectocele cases that cause severe defecation problems, pain in sexual intercourse and disturbed quality of life. Many different methods are being used in surgical treatment of rectocele. Most frequent methods are;
Weakened rectovaginal support tissue, which causes rectocele, is aimed to be strengthened by entering between the vagina and rectum. Artificial patch is providing highly successful results in recent years.
If a tear or damage in anal muscles that control gas and stool accompanies the rectocele, perineal muscle repair and approximation of levator muscles to the midline should be preferred methods.
This method is based on the principle of removing the excess rectum mucosa that is herniated towards the vagina with the use of surgical tools, which are inserted from the anus, called stapler. This is a novel method that does not affect post-op sex life especially in younger patients.
Abdominal repair is preferred in mild and severe rectocele diseases with downward prolapsed bowels. Rectocele is repaired with laparoscopic method using 3 punctures on the abdomen. This is one of the best techniques to provide good quality of life for the patients after the operation.
Rectocele is a pelvic floor disease. However, majority of the patients may have other accompanying pelvic floor diseases such as bladder prolapse (cystocele) and/or rectal prolapse. Some of the rectocele patients have prolapsed anus, uterus and bladder (descending perineum syndrome).Rectocele operation does not provide successful results in these patients. Main treatment of Descending Perineum Syndrome is to hang the replaced organs up with laparoscopic method. Therefore, it is very important to decide the correct surgical method through an extensive examination.