Rectocele
Description:
Rectocele (ректо + Greek kele protrusion, hernia, Xing.: the arkhotsel, the proktotsel) - spherical loss of a front wall of a rectum under skin through defect of muscles of a crotch.
Reasons of the Rectocele:
The injury and insufficiency of muscles of a crotch can be the cause of loss of a wall of a rectum. As a result of a wall prolapse in a rectum protrusion (pocket) is formed. In it the cap is late, especially at weakness of muscles of a pelvic bottom and decrease in a tone of a rectum. Does not result from full emptying directly of a gut at defecation. The rectocele meets more often at women of middle and advanced age.
Symptoms of the Rectocele:
The delay a calla in hernial protrusion causes a feeling of incomplete rectum emptying. Besides, the rectocele can cause locks a consequence of the complicated defecation, especially when weakening muscles of a crotch. Small (diameter less than 2 cm) hernial protrusions in most cases do not cause symptoms. Hernial protrusion of a front wall of a rectum reveal at hard filling it by means of a barium enema (irrigoskopiya). When emptying a large intestine from a baric suspension it is possible to see the remains of a contrast agent in a rectum pocket. At patients with locks which reason the rectocele is also incomplete emptying of a colon is at the same time observed. The symptoms inherent to a rectocele (feeling of incomplete rectum emptying, the complicated defecation and locks), are observed at a syndrome of the angry intestines and at a number of diseases of a rectum (a disheziya, an idiopathic megarectum, a disease of Girshprunga, proctites, tumors). In differential diagnosis it is necessary to consider communication of symptoms at a rectocele: injury and childbirth. Diagnostic difficulties are resolved when carrying out eentgenologichesky and proctologic researches. Differential diagnosis is helped by assessment of function of anorectal area by means of a manometriya with an electromyography, to a balloon manometriya and defecation. By means of a contrast defekografiya it is possible not only to reveal a rectocele, but also to carry out the differential diagnosis about a megarectum, a prolapse of the rectum, invagination and dysfunctions of a pelvic bottom.
Defect of muscles of a crotch with formation of a rectocele
Treatment of the Rectocele:
The rectocele is eliminated in the surgical way, but operation not always leads to recovery. Van Laarhoven C.J. and соавт. (1999) estimated results of surgical treatment of a rectocele at 26 women at terms from 5 to 54 months. The analysis of the complaints given to an anorectal manometriya and a defekografiya showed that at 3/4 patients the feeling of incomplete rectum emptying considerably decreased and evacuation improved. However, at the sizes of a rectocele more than 2 cm expressiveness of clinical symptoms not always corresponded to the volume of hernial protrusion. Therefore authors suggest to use, in addition to elimination of hernial protrusion, a number of other operative measures directed to recovery of function of muscles of a pelvic bottom, use of a special grid, etc. Prevention of appearance of a rectocele is promoted by the prevention of the birth trauma connected with a rupture of muscles of a pelvic bottom, etc. The forecast in general favorable though disturbances of defecation at patients with a big rectocele, can worsen quality of life considerably. At operational treatment it is important to consider function of muscles of a pelvic bottom and other indicators, and not just the sizes of a rectocele.
