EpistemisRectocele
Specialty: Gynecology and breast.
Why it occurs
- Defect of the rectovaginal fascia and attenuation of the perineal body after vaginal births or poorly healed episiotomies
- Severe chronic constipation with prolonged pushing for years
- Hypoestrogenism
- Obesity and increased pelvic pressure
- Previous hysterectomy
Initial workup
Bimanual gynecological examination and combined rectovaginal examination to assess the integrity of the rectovaginal septum and anal sphincter. Classification using the POP-Q system. Defecography (radiological or magnetic resonance) if there are doubts about defecatory dynamics or suspicion of concomitant enterocele/sigmoidocele. Anorectal manometry if underlying fecal incontinence is associated.
red flags
Severe defecatory obstruction with retention of feces for prolonged periods, forced need for defecation by means of digito-pressure on the posterior vaginal wall (vaginal splinting maneuver) to achieve rectal evacuation, ulceration and bleeding of the extruded posterior vaginal mucosa, severe chronic perineal pain.
Standard management
- Dough-forming laxatives such as Plantago ovata (psyllium) 5-10 g orally per day to ensure soft stools and avoid straining
- Stool softeners such as polyethylene glycol (PEG) 10-17 g per day in solution
- Local estrogens in cream for atrophic vaginal mucosa. Definitive treatment by posterior colporrhaphy (repair of the rectovaginal septum) or perineorrhaphy if there is significant involvement of the perineal body (note: avoid irritating laxatives or stimulants that cause cramps and diarrhea).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 5
- Treatment options
- 3