Incidence of occult rectal prolapse in patients with clinical rectoceles and defecatory dysfunction

Thompson, Jason; Chen, Anita H.; Pettit, Paul; Bridges, Mellena D.

doi:10.1067/mob.2002.129162

Cited by 62 publications

(50 citation statements)

References 20 publications

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“…Using 3-DAUS, we identified isolated and associated posterior dysfunctions and determined rectocele size. The prevalence of significant rectocele, anismus and rectal intussusception in our population (women with ODS) was similar to that of other series (13,23,29) . Rectocele grade II or III, rectal intussusception, rectocele associated with rectal intussusception and sphincter injury were found to be more prevalent in group II (>50y).…”

Section: Resultssupporting

confidence: 69%

“…Because of differences in measurement techniques and anatomical landmarks, some authors describe rectocele as a descent of the rectal ampulla, quantified by correlation with the inferoposterior margin of the symphysis pubis (8,12) , while others consider rectocele a herniation of the anterior rectal wall into the posterior vagina, the size of which determines the grade of rectocele (2,3,9,13,15,17,19,20,23,27,29) . Using 3-DAUS, we identified isolated and associated posterior dysfunctions and determined rectocele size.…”

Section: Resultsmentioning

confidence: 99%

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Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Murad-Regadas

Regadas

Rodrigues

et al. 2011

Arq. Gastroenterol.

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-Context -The correlation between vaginal delivery, age and pelvic floor dysfunctions involving obstructed defecation is still a matter of controversy. Objectives -To determine the influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions in women with obstructed defecation syndrome. Methods -Four hundred sixty-nine females with obstructed defecation syndrome were retrospectively evaluated using dynamic 3D ultrasonography to quantify posterior pelvic floor dysfunctions (rectocele grade II or III, rectal intussusception, paradoxical contraction/non-relaxation of the puborectalis and entero/ sigmoidocele grade III). In addition, sphincter damage was evaluated. Patients were grouped according to age (≤50y x >50y) and stratified by mode of delivery and parity: group I (≤50y): 218 patients, 75 nulliparous, 64 vaginal delivery and 79 only cesarean section and group II (>50y): 251 patients, 60 nulliparous, 148 vaginal delivery and 43 only caesarean section. Additionally, patients were stratified by number of vaginal deliveries: 0 -nulliparous (n = 135), 1 -vaginal (n = 46), >1 -vaginal (n = 166). Results -Rectocele grade II or III, intussusception, rectocele + intussusception and sphincter damage were more prevalent in Group II (P = 0.0432; P = 0.0028; P = 0.0178; P = 0.0001). The stratified groups (nulliparous, vaginal delivery and cesarean) did not differ significantly with regard to rectocele, intussusception or anismus in each age group. Entero/sigmoidocele was more prevalent in the vaginal group ≤50y and in the nulliparous and vaginal groups >50y. No correlation was found between rectocele and the number of vaginal deliveries. Conclusion -Higher age (>50 years) was shown to influence the prevalence of significant rectocele, intussusception and sphincter damage in women. However, delivery mode and parity were not correlated with the prevalence of rectocele, intussusception and anismus in women with obstructed defecation.

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Section: Resultssupporting

confidence: 69%

Section: Resultsmentioning

confidence: 99%

Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Murad-Regadas

Regadas

Rodrigues

et al. 2011

Arq. Gastroenterol.

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“…Of more recent interest is the problem of occult rectal prolapse in patients with clinical rectoceles [ 16 ]. Investigations of symptoms may reveal that patients with a rectocele may have a rectorectal or rectoanal intussusception.…”

Section: Rectocelementioning

confidence: 99%

Rectocele Pathophysiology and Presentation

Nugent

2013

Anus

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A rectocele is defi ned as the herniation or bulging of the posterior vaginal wall. The posterior vaginal wall and the anterior rectal wall are in direct apposition, and this bulging may be thought of as the rectum pushing anteriorly into the vagina.Rectoceles may present in isolation but may also often be associated with pelvic organ prolapse (POP). POP describes the herniation of one or more of the pelvic organs including the uterus, the apex of the vagina, the bladder or the rectum from its normal anatomical position into or occasionally beyond the vagina. PrevalencePelvic organ prolapse is common. In the United States, more than 200,000 operations are performed annually for one or more of the different presentations of pelvic organ prolapse, and numbers of women presenting for surgery for prolapse are increasing. The majority of pelvic organ prolapse is mild; however, prolapse beyond the vaginal introitus may occur in up to 5 % of cases. The Women's Health Initiative published in 2002 [ 1 ] suggested that in women aged between 50 and 79 years of age, up to 41 % of patients will present with some degree of POP, 18.3 % with a rectocele. However, the majority of these women are symptom free, and therefore, these prolapses may not be clinically signifi cant. Several larger studies have shown a lifetime risk of symptomatic POP of around 11 % [ 2 , 3 ]. As well as presenting with symptoms of bulge in prolapse, patients with pelvic fl oor disorders may also present with coexisting urinary or anal incontinence, and these symptoms often affect their quality of life, more than the prolapse itself.The prevalence of rectoceles (either with or without POP) depends on whether they are asymptomatic or symptomatic. In a study from the 1980s, radiological rectoceles were seen in 81 % of nulliparous asymptomatic women who were less than 35 years old [ 4 ]. Forty-eight percent of the female patients had rectoceles that were greater than 1 cm in size, and one had one >2 cm. Coexistent intussusception was present in 50 % of women. A Swedish study invited female patients between 20 and 59 years of age for a gynaecological health examination [ 5 ]. 14.4 % of the population had a rectocele.In 1997 the costs of repairing rectoceles in the United States (with or without other prolapse procedures) ran to $75 million [ 6 , 7 ]. It is estimated that with an ever-increasing aging population, the healthcare costs for managing symptomatic rectoceles (along with other POP) will be enormous. The lifetime risk for undergoing a single operation for pelvic fl oor dysfunction is estimated to be 11.1 %, and up to 29 % of patients required reoperation [ 2 ].

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“…Descensus perinei, Sphinkterinsuffizienz, innerer Rektumprolaps) vorliegt, ist die Frage, ob die Rektozele für die Entleerungsstörung ursächlich ist, klinisch schwer zu entscheiden [1][2][3], insbesondere da die Rektozele auch bei asymptomatischen Frauen häufig nachzuweisen ist. Weiterhin uneinheitlich bewertet wird zudem die Frage, inwieweit eine ventrale Rektozele kombiniert mit innerem Rektumprolaps (Intussuszeption) ein obstruktives Defäkationsssyndrom (ODS) verursacht und zu typischen Symptomen der Entleerungsstörung führt [4,5]. …”

Section: Introductionunclassified

Die STARR-Operation: Indikation, Technik und Ergebnisse

Schwandner¹

2007

Visc Med

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Rectocele and rectoanal intussusception are frequent clinical findings in patients suffering from refractory constipation that may be best characterized as obstructive defecation syndrome (ODS). However, there is still no clear evidence whether or not the STARR (stapled transanal rectal resection) procedure provides a safe and effective surgical option for symptom resolution in ODS patients as evidence-based guidelines and functional long-term results are still missing. Based on published data, the STARR procedure can be performed safely with low morbidity. The definite role of the STARR procedure has to be assessed by careful and prospective evaluation of long-term function and quality of life. Such data are provided by e.g. the German STARR registry.

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Incidence of occult rectal prolapse in patients with clinical rectoceles and defecatory dysfunction

Cited by 62 publications

References 20 publications

Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions

Rectocele Pathophysiology and Presentation

Die STARR-Operation: Indikation, Technik und Ergebnisse

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