Rectocele and intussusception: is there any coherence in symptoms or additional pelvic floor disorders?

Abstract

Patients with a symptomatic rectocele frequently have other pelvic floor disorders that significantly influence the pattern of symptoms. Knowledge of all the afflictions is essential for determining the optimal treatment for each individual patient.

Rectocele—does the size matter?

“…Straining during defecation was not related to the size of the rectoceles in our cohort of patients. Previous studies had shown that symptomatic rectoceles often occur in combination with other pelvic organ prolapse and anismus [24,35,36]. The occurrence of multiple pelvic organ prolapse can be explained as expressions of a weak pelvic floor.…”

“…Rectoceles were present in up to one third of patients with fecal incontinence [23]. The proposed mechanism of fecal incontinence is a leakage of stool retained in the rectoceles, especially in patients with anal weakness [22,24]. Sphincter weakness due to pudendal neuropathy caused by long standing obstructive constipation is another possible mechanism [3].…”

Rectocele or stool quality: what matters more for symptoms of obstructed defecation?

“…This may limit the validity of our findings, and other results may be obtained in a group of patients primarily seen for anorectal dysfunction, such as in a colorectal referral practice, who are likely to present with a different mix of symptoms and anatomical findings. It is well recognised that rectocele is frequently associated with other anatomical or functional disorders [21], and the prevalence of either will depend on the individual practice. In particular, it is likely that a gynaecologist will mostly see patients with mild symptoms rather than those at the more severe end of the spectrum.…”

Rectal intussusception is associated with abnormal levator ani muscle structure and morphometry

“…However, it is a relatively uncommon investigative tool in urogynaecology, due to cost and access problems. More recently, magnetic resonance imaging is used for defecography in order to allow diagnosis of other pelvic floor disorders, which are common in patients with obstructed defecation [18]. Recent studies comparing defecography and the more accessible translabial ultrasound demonstrated that ultrasound can also be used to diagnose rectal intussusception [19,20].…”