What is “rectocele” and what consequences does it have (also in the sexual sphere)?

I am 50 years old and I suffer from constipation. The gynecologist told me I have a rectocele. Could this be the cause of my constipation?

He replies Pierpaolo Sileridirector of the Coloproctological Surgery Unit, chronic intestinal diseases, San Raffaele Hospital, Milan

The rectocele a weakening of the wall between the vagina and rectum, which for this reason takes on the shape of a pocket of variable dimensions. A rectocele does not always lead to constipation, but when feces reach this pocket during defecation, a complete evacuation may not be achieved, You may experience perineal pain and a sense of weight, as well as abdominal discomfort. They can associate with these urinary and sexual problems, such as vaginal pain during intercourse. These are symptoms that appear quietly, usually after the age of 40, and become more evident after the age of 50. Age is the greatest risk factor and a certain degree of natural tissue relaxation. Number of pregnancies, body weight (overweight, but also rapid and lasting weight loss), physical effort, removal of the uterus are other factors to consider.

The diagnosis

It can also exist a genetic predisposition. A history of chronic constipation from a young age can contribute, due to continuous effort, to the formation of the rectocele. Returning to the specific case, the diagnosis of the rectocele was made with a gynecological examination, but to understand if there are other anatomical defects and how much the pouch interferes with defecation, it will be necessary to a visit to the colorectal surgeon and a defecographic examination to evaluate the coexistence of other anatomical defects of the rectum and pelvic floor. Defecography, or rather colpocystodefecography through contrast agents in the rectum, vagina and bladder can be given information on anatomical defects (extent of prolapse, presence of cystocele, enterocele, colpocele, laxity of the pelvic floor, muscular incoordination). Diagnostic accuracy allows a treatment that is as personalized as possible. Surgery is not always necessary.

The treatment

If there is muscular incoordination, the first treatment will be rehabilitative gymnastics. If there is a correlation between the anatomical defect and severe constipation, the procedure will beintervention. If it is a rectal prolapse with rectocele and prolapse of other structures, such as the uterus or bladder, a decision will be made to a minimally invasive abdominal operation. These interventions are conducted in reference centers robotically with greater precision, fewer complications and fast recovery. When faced with a small rectocele, it is preferable a transanal intervention to remove the pocket and prolapse.

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