Does Rectocele on Defecography Equate to Rectocele on Physical Examination in Patients With Defecatory Symptoms?

Wallace, Shannon L.; Torosis, Michele; Rogo-Gupta, Lisa

doi:10.1097/spv.0000000000000719

Cited by 10 publications

(16 citation statements)

References 23 publications

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“…However, it is also possible that this small difference suggests that these 2 groups represent 2 distinct phenotypes. This is consistent with a retrospective cohort study published by Wallace et al 22 in 2019 that found that evidence of a rectocele on defecography does not necessarily associate with PVWP on examination in patients with defecatory symptoms. Thus, there are 2 possible explanations for this finding: one is that women with prolapse and radiographic rectoceles represent a different phenotype or possibility that there is a continuum of prolapse development where women without clinical prolapse are on an early spectrum of that continuum.…”

Section: Discussionsupporting

confidence: 92%

Rectoceles: Is There a Correlation Between Presence of Vaginal Prolapse and Radiographic Findings in Symptomatic Women?

Ortega

Johnson

Janmey

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Constipation is highly prevalent. Women with constipation are evaluated for the presence of vaginal prolapse that may contribute to obstructed defecation syndrome. Defecography can identify anatomic causes of obstructed defecation syndrome (rectocele, intussusception, and enterocele). OBJECTIVE:This study aimed to assess the characteristics of women with obstructed defecation syndrome and radiographic rectoceles with and without posterior vaginal wall prolapse and to characterize the relationship between anatomical abnormalities and dysfunction.DESIGN: This is a retrospective case-control study of women with obstructed defecation syndrome who had radiographic rectoceles on defecography. SETTINGS:Women who presented to a Pelvic Floor Disorders Center were included.PATIENTS: Cases were defined as constipated women with radiographic rectoceles and at least stage II posterior vaginal wall prolapse on examination. Controls were patients with radiographic rectoceles but without posterior vaginal wall prolapse on examination. MAIN OUTCOME MEASURES:Patient characteristics, anorectal testing results, and validated questionnaires were compared between groups. RESULTS:A total of 106 women met inclusion criteria. Women with posterior vaginal wall prolapse (48 (45.3%)) had larger rectoceles on defecography than women without it on examination (3.4 cm vs 3.0 cm, p < 0.01). Women with posterior vaginal wall prolapse on examination were more likely to splint during defecation than women without vaginal wall prolapse (63.8% vs 27.3%, p < 0.01). All other defecatory symptoms, anorectal manometry parameters, and questionnaire responses were similar between groups. LIMITATIONS:This study was limited by its retrospective study design. Our data were taken from a single institution within a center specializing in the treatment of pelvic floor disorders, potentially limiting generalizability.CONCLUSIONS: Patients with constipation, radiographic rectoceles, and vaginal prolapse may differ from those without evidence of prolapse. Patients with vaginal prolapse were more likely to splint to aide evacuation and demonstrated larger rectoceles on defecography. Further studies are needed to determine whether constipation Funding/Support: None reported.

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Section: Discussionsupporting

confidence: 92%

Rectoceles: Is There a Correlation Between Presence of Vaginal Prolapse and Radiographic Findings in Symptomatic Women?

Ortega

Johnson

Janmey

et al. 2022

Diseases of the Colon &Amp; Rectum

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“…Such postdefecation images may also reveal features of pelvic organ prolapse (e.g., enterocele or peritoneocele) that may not be evident on images during defecation (Figure). Barium trapping was more frequently observed with larger rectoceles in some 23,26 but not all studies 20 . Moreover, barium trapping does not predict the outcome after rectocele repair 27,28 .…”

Section: Diagnosis and Classificationmentioning

confidence: 92%

“…Barium trapping was more frequently observed with larger rectoceles in some 23,26 but not all studies. 20 Moreover, barium trapping does not predict the outcome after rectocele repair. 27,28 Hence, the utility of this feature to identify patients for surgery is unclear.…”

Section: Key Pointsmentioning

confidence: 99%

“…Stages 0 (none) to 4 (vaginal eversion) are defined as degrees of vaginal descent of the rectocele during maximum Valsalva maneuver or cough 19 . Among 200 symptomatic patients, the correlation between rectocele size on a standardized physical examination vs defecography was limited, but stronger in patients with a rectocele larger than 2 cm 20 . Arguably, these differences are at least partly explained by differences in techniques among these assessments (i.e., Valsalva maneuver in dorsal lithotomy position for physical examination and ultrasound vs evacuation of contrast in seated position during defecography).…”

Section: Diagnosis and Classificationmentioning

confidence: 99%

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Rectocele: Incidental or important? Observe or operate? Contemporary diagnosis and management in the multidisciplinary era

Bharucha

Knowles

2022

Neurogastroenterology Motil

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Background More common in older women than younger women, rectoceles may be secondary to pelvic floor weakness and/or pelvic floor dysfunction with impaired rectal evacuation. Rectoceles may be small (<2 cm), medium (2–4 cm), or large (>4 cm). Arguably, large rectoceles are more likely to be associated with symptoms (e.g., difficult defecation). It can be challenging to ascertain the extent to which a rectocele is secondary to pelvic floor dysfunction and/or whether a rectocele, rather than associated pelvic floor dysfunction, is responsible for symptoms. Surgical repair should be considered when initial treatment measures (e.g., bowel modifying agents and pelvic floor biofeedback therapy) are unsuccessful. Purpose We summarize the clinical features, diagnosis, and management of rectoceles, with an emphasis on outcomes after surgical repair. This review accompanies a retrospective analysis of outcomes after multidisciplinary, transvaginal rectocele repair procedures undertaken by three colorectal surgeons in 215 patients at a large teaching hospital in the UK. A majority of patients had a large rectocele. Some patients also underwent an anterior levatorplasty and/or an enterocele repair. All patients were jointly assessed, and some patients underwent surgery by colorectal and urogynecologic surgeons. In this cohort, the perioperative data, efficacy, and harms outcomes are comparable with historical data predominantly derived from retrospective series in which patients had a good outcome (67%–78%), symptoms of difficult defecation improved (30%–50%), and patients had a recurrent rectocele 2 years after surgery (17%). Building on these data, prospective studies that rigorously evaluate outcomes after surgical repair are necessary.

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“…Imaging, such as dynamic magnetic resonance imaging, has been evaluated in comparison with physical examination, but fluoroscopic defecography has not yet been standardized for the evaluation of pelvic organ prolapse 4,5 . A single-center retrospective review failed to show a correlation between rectocele size on defecography and physical examination 6 …”

mentioning

confidence: 99%

Rectocele: Correlation Between Defecography and Physical Examination

Crowder

Sayegh

Guaderrama³

et al. 2023

UROGC

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ImportanceThere is a lack of consensus regarding the clinical applicability of fluoroscopic defecography in evaluation of pelvic organ prolapse.ObjectivesThe aim was to evaluate the association between rectocele on defecography and posterior vaginal wall prolapse (PVWP) on physical examination. The secondary objective was to describe radiologic and clinical predictors of surgical intervention and outcomes.Study DesignThis was a retrospective review of patients enrolled in a large health maintenance organization who underwent defecography and were examined by a urogynecologist within 12 months. The electronic medical record was reviewed for demographic and clinical variables, including pelvic organ prolapse and defecatory symptoms, physical examination, and surgical intervention through 12 months after initial urogynecologic examination or 12 months after surgery if applicable.ResultsOne hundred eighty-six patients met inclusion criteria. Of those, 168 (90.3%) had a rectocele on defecography and 31 (16.6%) had PVWP at or beyond the hymen. Rectocele size on defecography was poorly correlated with PVWP stage (spearman ρ = 0.18). Forty patients underwent surgical intervention. Symptoms of splinting, digitation, and stool trapping were associated with surgical intervention (odds ratio, 4.24; 95% confidence interval, 1.59–11.34; P < 0.01) as was advanced PVWP stage (P < 0.01), while rectocele presence and size on defecography were not. Large rectocele size on defecography was correlated with persistent postoperative defecatory symptoms (P = 0.02).ConclusionsWe demonstrated a poor correlation between rectocele size on defecography and PVWP stage. Defecatory symptoms (splinting, digitation, stool trapping) and higher PVWP stage were associated with surgical intervention, while rectocele on defecography was not.

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Does Rectocele on Defecography Equate to Rectocele on Physical Examination in Patients With Defecatory Symptoms?

Cited by 10 publications

References 23 publications

Rectoceles: Is There a Correlation Between Presence of Vaginal Prolapse and Radiographic Findings in Symptomatic Women?

Rectoceles: Is There a Correlation Between Presence of Vaginal Prolapse and Radiographic Findings in Symptomatic Women?

Rectocele: Incidental or important? Observe or operate? Contemporary diagnosis and management in the multidisciplinary era

Rectocele: Correlation Between Defecography and Physical Examination

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