Rectocele – CAUSES rectocele
Classification and manifestations of rectocele
PROCTOLOGY – 2009
SURGICAL DIVISION CB 6 RZD – MOSCOW
Rectocele – is abnormal protrusion of the anterior wall of the rectum toward the vagina (often called a front rectocele). Less commonly, a protrusion is directed back toward anokopchikovoy ligament (posterior rectocele).
Rectocele appears when there is a weakening of the fascia, which is located between the vagina and rectum. Normally, this fascia is tough enough as it is fibrous tissue.
Rectocele can lead to labors and other processes in which notes the pressure on the fascia. Rectocele usually occurs in postmenopausal women, which is associated with decreased levels of estrogen – the female sex hormone that is responsible for the strength of the pelvic tissues.
At small sizes rectocele may not occur. In marked rectocele size may be accompanied by a significant protrusion of tissue through the vagina. Despite the fact that such a protrusion can be accompanied by discomfort, it rarely leads to pain. Treatment of rectocele can be both conservative and surgical.
Causes of rectocele
The most common cause of rectocele include pregnancy and childbirth. This is due to stretching and weakening of muscles, ligaments and fascia that hold the sheath in place during pregnancy and childbirth. Therefore, the more women were pregnancy and childbirth, the higher the risk of rectocele.
Not every woman who gave birth, develop rectocele. In some women, supporting apparatus, which consists of the muscles, ligaments and fascia, is very durable, so it is little subject to change when exposed to it, therefore, rectocele they had not encountered. Women who have had only a birth by caesarean section, much less at risk of rectocele.
Thus, among the causes of the rectocele, include:
- changes in the rectovaginal septum,
- changes in the muscles that raise the anus (called levator)
- congenital weakness of the muscles and ligaments of the core pelvic floor,
- dysfunction of the colon, often lasting constipation,
- dysfunction of the anal sphincter,
- dystrophy and atrophy of the rectovaginal septum, and pelvic floor muscles associated with age-related changes,
- diseases of the female genital organs
- Chronic bronchitis is accompanied by severe prolonged cough,
- frequent heavy lifting,
So, apparently, causes rectocele, in addition to pregnancy and childbirth, a lot, and sometimes reveal the true cause of rectocele is difficult.
The main reason for the protrusion of the rectal wall – a chronic increase in intra-abdominal pressure, as well as the factors that lead to trauma and the weakening of the fascia between the rectum and the vagina.
The researchers found that most of the women early signs associated rectocele, usually carried over to the childbirth and pregnancy. And in more than half of cases, these women were obstructed labor, the fetus was large and there were tears of the perineum.
Increased intra-abdominal pressure observed with other conditions such as chronic cough, constipation, when the patient is forced to push a long time. More than anything 80% of these patients appears constipated, they are forced to take laxatives. Rectocele occurs, and those engaged in heavy physical labor. In some cases, the cause of rectocele may be removal of the uterus (hysterectomy).
Trauma from the front of the muscles that raise the anus can also cause a weakening of the muscles and ligaments that support the pelvic floor. Rectovaginal septum becomes thinner and the rear wall of the vagina, which is closely connected with the rectum, becoming the first movable. During the increasing intra-abdominal pressure the front wall of the rectum protrudes and there is a rectocele.
The inherent weakness of the muscle and ligamentous structures of the pelvic floor can also be a cause of rectocele, including a young age after the first birth. Chronic constipation can be a contributing factor to the development of rectocele, both women and men.
For rectocele is marked not only the change of anatomical relationships, but also functional changes in the rectum, accompanied by a violation of her motor skills.
Manifestations of rectocele
At small sizes rectocele may be no symptoms. When expressed as rectocele size displays are bright character. The most common symptom is a violation of rectocele emptying the rectum. The patient has a feeling of incomplete emptying of the rectum. He was forced at times to empty it by hand allowances, as if squeezing the feces through the rear wall of the vagina into the rectum.
Incomplete emptying of the rectum resulting from the fact that a patient having frequent urge to urinate. Continued stagnation of feces in the intestine and the violation of its discharge may cause inflammatory changes in it.
The development of rectocele occurs gradually. Initially, the patient noted a violation of emptying the rectum. They often have to push. Then join a feeling of incomplete emptying of the rectum. The patient began to use laxatives, cleansing enemas. A few years later, when the size of the rectocele becomes even more necessary to empty the rectum with his hands, "squeezing" out the back cal back wall of the vagina into the rectum.
Prolonged straining causes the trauma of the mucous membrane of anal canal, there are complications such as chronic hemorrhoids, anal fissure, rectal fistula, chronic crypto, etc.
Many women with rectocele may also be other diseases associated with this disease:
- cystocele – protrusion of the bladder wall through the vaginal wall
- enterocele – protrusion through the vaginal wall of the small intestine
- uterine prolapse – prolapse of the uterus through the vagina.
Classification of rectocele
Depending on the severity of clinical manifestations of rectocele is divided into three stages:
- first degree is determined only by digital rectal examination. Rectocele is detected in the form of pocket.
- second degree rectocele is characterized by a pronounced pocket of the rectum into the vagina. There is a feeling of incomplete emptying of the bowel, impaired defecation.
- third degree rectocele is accompanied by bulging of the back wall of the vagina for the redistribution of the genital slit, both at rest and during increased abdominal pressure (straining). In patients, frequent urge to defecate, feeling of incomplete emptying of the rectum.
CENTER PROCTOLOGY Professor PROMA – GERMANY
SURGICAL DIVISION CB 6 RZD – MOSCOW
Examination and treatment in GERMANY – Institute "DIAGNOSTIX"
AID IN THE TREATMENT –
Diagnosis of rectocele
Treatment of rectocele