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Posterior Vaginal Prolapse (Rectocele)

Home Posterior Vaginal Prolapse (Rectocele)

Introduction

Posterior Vaginal Prolapse is also referred to as rectocele, and according to the American Society of Colon and Rectal Surgeons, it is present in about 40% of females. This condition might go unnoticed by them for a while, but a proper physical examination can help begin the course of treatment.

Nevertheless, it is a serious medical condition expected to increase at a high rate in the future. Thus, it’s crucial to learn more about it.

A Rectocele is a type of pelvic organ prolapse that occurs when the supportive tissue wall between the rectum and the vaginal wall significantly weakens. In the absence of the support of the pelvic ligaments and floor muscles, the frontal vaginal wall bulges. In extreme cases, this hernia-like bulge will protrude out of the vagina’s opening. Thus, it may cause discomfort to the female, but it is seldom painful.

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What are the Causes of Posterior Vaginal Prolapse (Rectocele)?

There are quite a few factors that can cause Posterior Vaginal Prolapse (rectocele). All of them are given below:

  • Ageing: Naturally, your muscles will start losing mass, nerve function, elasticity, and get weakened as you age. By the time women hit 50, almost half of them show symptoms of posterior vaginal prolapse. Furthermore, at the age of 80, it becomes more frequent as every 1 in 10 women will undergo surgery for the prolapse.
  • Pregnancy and childbirth: During pregnancy, delivery, and labour, the ligaments, connective tissues, and muscles that support the vagina are weakened and stretched. The probability increases in the case of the baby weighing over 9 pounds, prolonged labour, and multiple births (for instance, twins.)
  • Genetics: Due to genetic mutation or some fault in the genes, some women are naturally born with weaker muscles and connective tissues in the pelvic floor. Thus, it makes them susceptible to develop rectocele.
  • Obesity: When you are overweight, it tends to put a lot of pressure on your pelvic area muscles and tissues. Therefore, it will eventually cause them to weaken and make you vulnerable to this condition.
  • Menopause: When women hit menopause, typically during the age of 55-60, their estrogen levels considerably drop. It makes the pelvic tissue lose its elasticity.

 

Some other factors are:

  • ● Repeatedly lifting heavy items
  • ● Chronic bronchitis
  • ● Chronic constipation
  • ● Any pelvic floor surgery
  • ● Childhood sexual abuse

What are the Symptoms of Posterior Vaginal Prolapse (Rectocele)?

Some women show no symptoms, while others show almost all symptoms. Therefore, it varies from female to female. Many women have reported that they feel that something is ‘falling out’ of their vagina and high vaginal pressure. Other symptoms include:

  • ● Difficulty in having or completing a bowel movement.
  • ● Experiencing discomfort during sexual encounters.
  • ● A soft bulge that protrudes out of the vagina or is felt in the vagina.
  • ● Rectal pressure/fullness.

Many females who experience rectocele also experience other types of prolapse in the pelvic region, for instance, the uterus or the bladder.

How is Posterior Vaginal Prolapse (Rectocele) Diagnosed?

The diagnosis of rectocele usually occurs during a physical pelvic exam for your rectum and vagina. Here are some ways to diagnose rectocele:

Pelvic exam

During this exam, the doctor will most likely ask you to:

  1. Bear down or sit down as if you are experiencing a bowel movement. This will lead to the prolapse to bulge for the doctor to examine its location and size.
  2. Tighten your pelvic floor muscles as if you’re halting your urine flow. This will tell the doctor how strong your pelvic area muscles are.

Although it is rare, the doctor might recommend you take up imagining tests like:

  • ● MRI
  • ● X-ray
  • Defecography: A particular type of X-ray review that assists the doctors in determining the bulge’s size and the patient’s evacuating extent.
  • ● Ultrasound

How is Posterior Vaginal Prolapse (Rectocele) Treated?

Prevention

As prevention is better than cure, you can follow the below guidelines to prevent yourself from having this condition. Please note that these tips will also stop the symptoms from worsening if the rectocele is already existing.

  • ● Kegel exercises or pelvic floor exercises
  • ● Eating fibrous foods and drinking plenty of fluids will reduce constipation.
  • ● Avoiding any heavyweight lifting
  • ● Getting treated for prolonged coughing will reduce the stress on the pelvic area muscles.
  • ● If you are obese or overweight, then losing weight is advisable.

Non-surgical treatment

The courses of treatment for Posterior Vaginal Prolapse (Rectocele) are:

  • Pessary: A vaginal pessary is a type of rubber or plastic ring stuck in your vagina to aid the bulging tissues. For hygiene purposes must be removed from time to time for cleaning.
  • Medications: The doctor may prescribe medicines such as:
  • ● Stool softeners to reduce constipation.
  • ● HRT or hormone replacement surgery after menopause.

Surgical treatment

  • Rectocele repair: Surgery is performed in cases when the prolapse protrudes out of your vagina or if you have another prolapse like uterine or vault excluding the posterior vaginal prolapse. The surgery consists of eliminating excess, stretched connective tissues that form the bulge and suturing it to support the pelvic floor.

Result

Surgical treatments often show optimistic results in most cases. However, non-surgical treatment like pessary has shown a considerable amount of success rate too. Lifestyle changes made early on in your life is the best way to prevent this condition.

What are the Risks Associated with Posterior Vaginal Prolapse (Rectocele) treatments?

Risks of Rectocele repair are:

  • ● Development of fistula or an open channel between the rectum and the vagina
  • ● Infection
  • ● Pain or discomfort during sexual intercourse
  • ● Bleeding
  • ● Recurrence of rectocele

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FAQ's

What Happens if the Rectocele is not Treated?

If it is not treated, the following may happen-

  • ● Discomfort in the pelvic floor
  • ● Sexual dysfunction
  • ● Leakage of bowel movements
  • ● Constipation

Can Diet Prevent Rectocele?

Diet can significantly contribute to preventing Rectocele. This can be done by incorporating at least 25-30 g of fibre in your everyday diet with increased water intake.

What is the Success Rate of Rectocele Surgery?

This procedure’s success rate is about 80-90% depending on the type of technique used.

Which Type of Surgeon Performs the Rectocele Repair?

Colorectal surgeons perform the Rectocele repair.

What is the Recovery Period for Rectocele Surgery?

The typical recovery period for Rectocele surgery is about 2-3 weeks. Furthermore, you should avoid sexual intercourse for at least 6 weeks after the surgery.

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