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Laparoscopic Rectocele repair

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What is a rectocele?
A rectocele is a bulge of the front wall of the rectum into the vagina. The rectal wall may become thin and weak and balloons into the vagina on straining. Other structures that may push into the vagina include the bladder (a cystocele) and the small intestines (an enterocele).

Whilst a rectocele may occur in isolation, in many cases a rectocele may be part of a more generalised weakness of pelvic support and may exist along with a rectal prolapse, vaginal/uterine prolapse, cystocele, enterocele and faecal or urinary incontinence.

What causes a rectocele?
The underlying cause is weakening of the pelvic support structures and thinning of the rectovaginal septum. Certain factors increase the risks of women developing a rectocele. These include; birth trauma (multiple, difficult, prolonged deliveries, forceps, perineal tears), chronic constipation or following a hysterectomy. They are more common with increasing age.

What are the symptoms?
Whilst many women have rectoceles, only a small percentage will have symptoms. Symptoms may be primarily rectal or vaginal. Vaginal symptoms include bulging, the sensation of a mass in the vagina, pain with intercourse, prolapse. Rectal symptoms include difficult evacuation; some women find that pressing against the lower back wall of the vaginal or along the rim of the vagina helps empty the rectum. At times, there will be a rapid return of the urge to have a bowel movement after leaving the toilet.

When should a rectocele be treated?

When it causes significant symptoms. It takes a very experienced Dr and a wekk carried out proctogram to help decide whether your symptoms are caused by a rectocele.  A defaecating proctogram is an x-ray study that shows how large the rectocele is and if the rectum empties completely with evacuation.  If there are multiple abnormalities present it may be best to address them all at once as this will result in the best chance for improvement.

A diet high in fibre and 6-8 glasses of water each day help. Avoid prolonged straining. If you cannot completely empty, stop and try again later. Holding pressure with a finger to support the rectocele and encourage the stool to go in the correct direction is often helpful. Glycerine suppositories sometimes help.
Surgical repair may be performed through the anus, vagina, through the perineum between anus and vagina or from above through the abdomen. The latter, BLAs prefered method, can be performed laparoscopicaly.

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