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rectocele; proctocele; rectal procidentia
Etiology:
- pregnancy & childbirth
- increased pressure on the pelvic floor exacerbated by
- upright position
- chronic constipation or straining with bowel movements
- chronic cough or bronchitis
- repeated heavy lifting
- overweight or obesity
Epidemiology:
- more common in older women
Pathology:
- occurs when the thin wall of fascia that separates the rectum from the vagina weakens, allowing the vaginal wall to bulge
- thus the anterior wall of the rectum bulges through the posterior wall of the vagina
Genetics:
- genetic predisposition
Clinical manifestations:
- may be asymptomatic
- may create a noticeable bulge of tissue through the vaginal opening
- may be uncomfortable, but rarely painful
- difficulty having a bowel movement
- need to press your fingers on the vaginal bulge push stool out during a bowel movement ("splinting")
- sensation of rectal pressure or fullness
- sensation of incomplete bowel evacuation
- sexual dysfunction due to concerns or embarrassment
Differential diagnosis:
- rectal prolapse
- cystocele (anterior prolapse)
- enterocele (apical prolapse)
- uterine prolapse
Management:
- medical management generally sufficient
- digital "splinting" as needed for defecation
- vaginal pessary may provide adequate splinting
- vaginal estrogen or barrier cream if vaginal wall is irritated
- dietary fiber, stool softeners, suppositories
- surgery
- generally effective in the short-term
- long-term success rates lower than short-term results [2]
Related
rectal prolapse; proctoptosis
General
pelvic organ prolapse
References
- Stedman's Medical Dictionary 27th ed, Williams &
Wilkins, Baltimore, 1999
- Mayo Clinic; Posterior Prolapse
http://www.mayoclinic.org/diseases-conditions/rectocele/basics/definition/con-20027826
- Geriatric Review Syllabus, 8th edition (GRS8)
Durso SC and Sullivan GN (eds)
American Geriatrics Society, 2013