Materiały źródłowe

• #1 Rectocele: Causes, Symptoms, Diagnosis, Stages & Treatment

  https://my.clevelandclinic.org/health/diseases/17415-rectocele

  A rectocele is a condition where weakened tissues in your pelvis cause your rectum to sag onto your vaginal wall. Its a form of pelvic organ prolapse. […] Rectocele is also called posterior vaginal wall prolapse. […] Gynecologists can often diagnose a rectocele with a thorough medical history and physical exam. […] Diagnosis may include: Pelvic exam: In addition to examining your vaginal canal for signs of prolapse, your provider may test your pelvic floor strength during the exam. […] Imaging isn’t often used for rectocele diagnosis. In rare instances, your provider may order a transvaginal ultrasound to check if your small intestine has prolapsed (enterocele). […] A surgical procedure called posterior colporrhaphy is commonly used to repair rectoceles. […] Often, your provider performs rectocele surgeries through your vagina, an approach that leaves no scars. […] Speak to your provider about treatment options if you have to use your fingers to have a bowel movement.

• #2 Posterior vaginal prolapse (rectocele) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectocele/symptoms-causes/syc-20353414

  A posterior vaginal prolapse, also known as a rectocele, occurs when the wall of tissue that separates the rectum from the vagina weakens or tears. When this happens, tissues or structures just behind the vaginal wall in this case, the rectum can bulge into the vagina. […] A posterior vaginal prolapse is a bulge of tissue into the vagina. It happens when the tissue between the rectum and the vagina weakens or tears. This causes the rectum to push into the vaginal wall. Posterior vaginal prolapse is also called a rectocele (REK-toe-seel). […] A small posterior vaginal prolapse (rectocele) might cause no symptoms. […] Many women with posterior vaginal prolapse also have prolapse of other pelvic organs, such as the bladder or uterus. A surgeon can evaluate the prolapse and talk about options for surgery to fix it.

• #3 Rectocele (Posterior Prolapse) – Alaska Urology

  https://www.alaskaurology.com/womens-health/rectocele-posterior-prolapse/

  A posterior vaginal wall prolapse occurs when the thin wall of tissue that separates the rectum from the vagina weakens, allowing the vaginal wall to bulge. Posterior vaginal prolapse is also called a rectocele (REK-toe-seel). […] If a posterior vaginal prolapse is large, it may create a noticeable bulge of tissue through the vaginal opening. […] A small posterior vaginal prolapse (rectocele) may cause no signs or symptoms. […] Posterior vaginal prolapse is common, even in women who havent had children. […] See your doctor if: […] Posterior vaginal prolapse results from pressure on the pelvic floor. […] The more pregnancies you have, the greater your chance of developing posterior vaginal prolapse. […] If you have vaginally delivered multiple children, you have a higher risk of developing posterior vaginal prolapse. […] Treatment depends on the severity of the posterior vaginal prolapse. […] Surgical repair might be needed if: […] The surgery uses a vaginal approach and usually consists of removing excess, stretched tissue that forms the posterior vaginal prolapse.

• #4 The Pathophysiology, Diagnosis, and Management of Rectoceles | GLOWM

  https://www.glowm.com/section-view/heading/The-Pathophysiology-Diagnosis-and-Management-of-Rectoceles/item/58

  A rectocele is an outpocketing of the anterior rectal and posterior vaginal wall into the lumen of the vagina. Some rectoceles may be asymptomatic, whereas others may cause symptoms of incomplete bowel emptying, vaginal mass, pain, and pressure. The incidence of rectoceles is 20-80% in the general population and is thought to be increasing. This chapter reviews the anatomy, pathophysiology, diagnosis, and management of rectoceles. […] Physical examination usually begins in the dorsal supine position for the gynecologist and the left lateral decubitus position for the colorectal surgeon. […] Of women with rectoceles, 80% are asymptomatic and can be diagnosed only on physical examination. Additional diagnostic tests may assist the physician in the evaluation of posterior vaginal wall defects and defecatory dysfunction.

• #5 Mayo Clinic Health Library – Posterior vaginal prolapse (rectocele) | Swiss Medical Network

  https://www.swissmedical.net/en/healtcare-library/con-20314570

  A diagnosis of posterior vaginal prolapse often happens during a pelvic exam of the vagina and rectum. […] The pelvic exam might involve: […] Bearing down as if having a bowel movement. Bearing down might cause the prolapse to bulge, revealing its size and location. […] Tightening pelvic muscles as if stopping a stream of urine. This test checks the strength of the pelvic muscles. […] You might fill out a questionnaire to assess your condition. Your answers can tell your health care provider about how far the bulge extends into the vagina and how much it affects your quality of life. This information helps guide treatment decisions. […] Rarely, you might need an imaging test: […] MRI or an X-ray can determine the size of the tissue bulge. […] Defecography is a test to check how well your rectum empties. The procedure combines the use of a contrasting agent with an imaging study, such as X-ray or MRI.

• #6 Anterior and Posterior Vaginal Wall Prolapse – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/pelvic-organ-prolapse-pop/anterior-and-posterior-vaginal-wall-prolapse

  Posterior vaginal wall prolapse is commonly referred to as enterocele (small intestine and parietal peritoneum) and rectocele (rectum). […] Diagnosis of vaginal wall prolapse is made clinically with pelvic examination by retracting the posterior vaginal wall and observing the anterior vaginal wall with the patient at rest and then with the patient straining. […] Diagnose enterocele or rectocele on pelvic examination by retracting the anterior vaginal wall and observing the posterior vaginal wall with the patient at rest and then with the patient straining, and with a rectovaginal examination. […] First-line conservative treatment options include pelvic floor physical therapy (for less severe pelvic organ prolapse) and pessaries, with surgical options available based on patient preference and clinical pelvic organ prolapse severity.

• #7

  https://www.kuh.ku.edu.tr/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/posterior-vaginal-prolapse-rectocele

  Posterior vaginal prolapse (rectocele) Last Updated on July 25, 2024 Overview A posterior vaginal prolapse is a bulge of tissue into the vagina. It happens when the tissue between the rectum and the vagina weakens or tears. This causes the rectum to push into the vaginal wall. Posterior vaginal prolapse is also called a rectocele (REK-toe-seel). […] Diagnosis A diagnosis of posterior vaginal prolapse often happens during a pelvic exam of the vagina and rectum. The pelvic exam might involve: Bearing down as if having a bowel movement. Bearing down might cause the prolapse to bulge, revealing its size and location. Tightening pelvic muscles as if stopping a stream of urine. This test checks the strength of the pelvic muscles. […] You might fill out a questionnaire to assess your condition. Your answers can tell your health care provider about how far the bulge extends into the vagina and how much it affects your quality of life. This information helps guide treatment decisions. […] Rarely, you might need an imaging test: MRI or an X-ray can determine the size of the tissue bulge. Defecography is a test to check how well your rectum empties. The procedure combines the use of a contrasting agent with an imaging study, such as X-ray or MRI.

• #8 Rectocele Clinical Presentation: Physical Examination

  https://emedicine.medscape.com/article/268546-clinical

  The pelvic examination findings should define the degree of prolapse and help determine the integrity of the connective tissue and muscular support of the pelvic organs. The pelvic examination is best performed with the patient in the dorsal lithotomy position, with her head elevated 45 (which allows for maximal Valsalva). Rectocele is suspected when posterior wall bulging is noted. […] The extent of prolapse must be documented. One method is to measure the degree of descent with respect to the hymenal ring. The Pelvic Organ Prolapse Quantitation (POPQ) examination is the most widely accepted at this time and has been adopted by the International Continence Society, the American Urogynecologic Society, and the Society of Gynecologic Surgeons. […] Anterior displacement of the rectal wall observed upon rectovaginal examination is diagnostic of rectocele. […] Diagnosis of perineal descent is made if the perineum is noted to be below this level either at rest or with straining. […] The bimanual examination is used to investigate the location, size, and tenderness of the cervix, uterus, bladder, and adnexa.

• #9 Pelvic Organ Prolapse: Types, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24046-pelvic-organ-prolapse

  Weakened pelvic floor muscles between your vagina and rectum can cause your rectum to bulge onto the back wall of your vagina. […] During your appointment, your healthcare provider will review your symptoms and perform a pelvic exam. During the exam, your provider may ask you to cough so that they can see the full extent of your prolapse when you’re straining and when you’re relaxed. […] Additional tests may include pelvic floor function tests that allow your provider to see how strong the muscles and ligaments in your pelvis are. […] The Pelvic Organ Prolapse Quantification (POP-Q) system classifies POP based on how far your pelvic organs drop relative to your hymen. […] Your treatment plan will depend on how severe the prolapse is, where it is and how much your symptoms affect you.

• #10 Rectocele – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546689/

  The vaginal exam can be evaluated using the Baden-Walker or POP-Q exam. […] The posterior points Ap and Bp are the measurements needed to determine the severity of the rectocele. […] A rectocele occurs when healthy rectovaginal septal tissue loses integrity, and the rectum herniates through into the vaginal lumen. […] The management of this condition largely depends on the extent of the prolapse and the severity of the symptoms. […] Surgical management is reserved for those with obstructive defecatory symptoms and bothersome symptoms who have failed other forms of treatment. […] The principle of the surgical treatment is posterior vaginal wall or fibromuscular tissue repair or plication to strengthen the tissue and reduce the prolapsing rectum through the posterior vaginal wall. […] There is no consensus on the best approach or the best surgical repair for treating rectoceles.

• #11 Pelvic organ prolapse – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pelvic-organ-prolapse/

  Pelvic organ prolapse is a clinical diagnosis. […] Determine the location and severity of prolapse through clinical examination. […] Assess the impact of symptoms on daily life using a validated symptom questionnaire. […] Evaluate associated symptoms if present. […] Refer patients with atypical or complex symptoms to a specialist for imaging. […] Examine the external genitalia and perineum for skin irritation and/or breakdown. […] Assess for POP at rest and during the Valsalva maneuver. […] Perform a speculum examination to: […] Individually examine the anterior and posterior vaginal walls for prolapse during the Valsalva maneuver. […] Measure vaginal length. […] Perform a vaginal examination of the pelvic floor musculature. […] POP are staged with the patient maximally straining, using the Pelvic Organ Prolapse Quantification system.

• #12 Pelvic organ prolapse – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pelvic-organ-prolapse/

  Stage 0: no prolapse. […] Stage 1: The most distal portion of prolapse is 1 cm above the level of the hymen. […] Stage 2: The most distal portion of prolapse is 1 cm proximal or distal to the hymenal plane. […] Stage 3: The most distal portion of prolapse is 1 cm below the hymenal plane but no more than 2 cm less than the vaginal length. […] Stage 4: The vagina is completely everted or uterine procidentia has occurred.

• #13 Posterior vaginal prolapse (rectocele)

  https://www.mymlc.com/health-information/diseases-and-conditions/p/posterior-vaginal-prolapse-rectocele/?section=Lifestyle%20and%20home%20remedies

  A diagnosis of posterior vaginal prolapse generally occurs during a pelvic exam of your vagina and rectum. […] During the pelvic exam your doctor is likely to ask you: […] You might fill out a questionnaire that helps your doctor assess how far the bulge extends into your vagina and how much it affects your quality of life. This information helps guide treatment decisions. […] Rarely, your doctor might recommend imaging tests:

• #14 Posterior Vaginal Prolapse – Symptoms | Causes | Diagnosis | Treatment | Complications | Prevention

  https://www.icliniq.com/articles/womens-health/posterior-vaginal-prolapse

  Posterior vaginal prolapse occurs when the rectum sags into the vaginal wall. […] How Is Posterior Vaginal Prolapse Diagnosed? […] During the diagnosis of posterior vaginal prolapse, a pelvic examination of the vagina and rectum is done. […] Imaging is not often used for rectocele diagnosis. In rare instances, the doctor might ask for a transvaginal ultrasound to check if the small intestine has prolapsed. […] The goal of the surgery is to repair and strengthen the wall between the rectum and vagina. […] Surgery may be needed if the rectocele does not respond to other treatments and is causing discomfort for the patient. […] The posterior vaginal prolapse can be embarrassing and uncomfortable and make it difficult to empty bowel movements. […] In mild cases, it can be prevented with Kegels exercise, controlling constipation and obesity.

• #15 Pelvic organ prolapse – a review

  https://www.racgp.org.au/afp/2015/july/pelvic-organ-prolapse-a-review

  Levator avulsion can be diagnosed by palpation during pelvic floor muscle contraction. Avulsion increases the levator-urethra gap, allowing it to admit not one but two fingers, and no contractile tissue is felt on the inferior pubic ramus. Imaging is usually required for a formal diagnosis, and tomographic three- or four-dimensional (3D/4D) pelvic floor ultrasonography is becoming the diagnostic standard. […] This is performed by translabial ultrasonography, using abdominal curved array transducers placed in a mid-sagittal orientation on the perineum. The severity of FPOP is quantified against the symphyseal margin. […] Direct imaging of the levator is facilitated by 3D/4D ultrasonography, enabling diagnosis of avulsion and hiatal ballooning simply and non-invasively in an examination that takes, at most, 10 minutes and requires no preparation.

• #16 The relationship between obstructed defecation and true rectocele in patients with pelvic organ prolapse | Scientific Reports

  https://www.nature.com/articles/s41598-020-62376-2

  We aimed to investigate the prevalence of true rectocele and obstructed defecation (OD) in patients with pelvic organ prolapse (POP), to investigate the correlation between true rectocele and OD, and to understand the diagnostic value of translabial ultrasound (TLUS) in the diagnosis of true rectocele. […] The prevalence rate of true rectocele was 23%. […] True rectocele was significantly correlated with straining at stool, digitation, incomplete emptying and requirement of laxatives or enema. […] In POP patients, the prevalence rate of true rectocele and OD was 23% and 43%, respectively. […] TLUS was a valuable approach in anatomical evaluation of POP. […] Although video-defecography is considered to be the gold standard for the diagnosis of rectocele, a number of previous studies have confirmed that translabial ultrasound (TLUS) has good consistency and is in good agreement with video-defecography. […] We found that the diagnosis of rectocele by TLUS was related to OD, indicating a certain value in anatomical evaluation of POP. […] Collectively, TLUS was a valuable approach in anatomical evaluation of POP.

• #17 Rectocele: symptoms, diagnosis and treatment | Dr. Yannick Nijs

  https://www.surgery-brussels.be/conditions/rectocele/

  A rectocele is mostly discovered coincidently during a regular medical check-up. Extensive clinical examination and an ultrasound are essential for diagnosing rectocele and potentially expose other anomalies of the pelvic floor. […] In case the patient experiences difficulty in defecating, a special RX study is usually conducted. An RX-defecography involves injection of contrast material through the rectum after which several RX-photos are made while the patient defecates. This test gives doctors a clear image of the size of the rectocele size and other possible anomalies. […] Nowadays, doctors often turn to NMR-tests or NMR-defecographies as well to avoid using X-rays. This type of test also provides a clearer image of the pelvic floors anatomy. […] In some cases, a dynamic perineal ultrasound may be recommended.

• #18 How Can I Fix My Rectocele Naturally?

  https://www.medicinenet.com/how_can_i_fix_my_rectocele_naturally/article.htm

  As it is a structural (anatomical) defect, you cannot fix a rectocele by natural means alone. […] The treatment of rectocele (also known as posterior vaginal prolapse) depends on the severity of its symptoms, and surgery is the only definitive treatment to fix it. […] How is a rectocele diagnosed? […] Your doctor will take your complete medical history and ask you a few questions regarding your bowel movements and rectal as well as vaginal complaints. […] Next, the doctor will perform a pelvic examination that includes mainly, examining your vagina and rectum to look for features of rectocele and check if any other organ has also prolapsed. […] The doctor will order a few tests that include: […] Magnetic resonance imaging (MRI): This will help the doctor know the size of the rectocele.

• #19 Rectocele – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK546689/

  Rectoceles are a type of pelvic organ prolapse where the rectal tissue herniates through a defect in the rectovaginal septum into the vaginal lumen. […] The evaluation is largely clinical, and treatment depends on clinical assessment and severity of symptoms. […] This activity reviews the evaluation and treatment of rectoceles and highlights the role of the healthcare team in managing patients with this condition. […] Summarize the evaluation of rectocele. […] Evaluation of a rectocele is determined mainly by the clinical exam. Other laboratory tests and radiographic tests are generally not necessary. […] A special test that can be done to confirm a rectocele is defecography. […] Another useful diagnostic tool for surgical planning is dynamic MRI (DMRI) which provides visualization of the rectocele and movements of the pelvic floor.

• #20

  https://fascrs.org/patients/diseases-and-conditions/a-z/rectocele

  A rectocele is a bulging of the front wall of the rectum into the back wall of the vagina that may interfere with emptying of stool from the rectum. […] A rectocele is often found during a routine physical examination. However, other tests may be needed to help evaluate its severity or possible connection to symptoms. The following test may be ordered to confirm the diagnosis. […] Defecography: A special X-ray or MRI test that shows the rectum and anal canal as they change during defecation. This study is very specific and can pinpoint the size of the rectocele and the degree to which the rectum is emptied.

• #21 Rectocele – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546689/

  Rectoceles are a type of pelvic organ prolapse where the rectal tissue herniates through a defect in the rectovaginal septum into the vaginal lumen. […] The evaluation is largely clinical, and treatment depends on clinical assessment and severity of symptoms. […] This activity reviews the evaluation and treatment of rectoceles and highlights the role of the healthcare team in managing patients with this condition. […] Summarize the evaluation of rectocele. […] The evaluation of a rectocele is determined mainly by the clinical exam. Other laboratory tests and radiographic tests are generally not necessary. […] A special test that can be done to confirm a rectocele is defecography. […] Evaluation is determined mainly by the clinical exam. […] The focused neurological exam consists of levator ani muscle tone and contraction strength.

• #22 Rectocele – Wikipedia

  https://en.wikipedia.org/wiki/Rectocele

  In gynecology, a rectocele or posterior vaginal wall prolapse results when the rectum bulges (herniates) into the vagina. […] The diagnosis of a rectocele primarily occurs with a physical examination and an interview where symptoms of difficulty defecating are reported. Women often mention the need to insert a finger in the vagina or use of suppositories and/or enemas to aid in having a bowel movement. […] A pelvic exam and digital rectal exam are done to evaluate the amount of protrusion and anal sphincter tone. […] Fluoroscopic defecography (FD), evacuation proctography, or dynamic magnetic resonance imaging (MR defecography, MRD) may be used to evaluate functional and anatomic conditions.

• #23 The Pathophysiology, Diagnosis, and Management of Rectoceles | GLOWM

  https://www.glowm.com/section-view/heading/The-Pathophysiology-Diagnosis-and-Management-of-Rectoceles/item/58

  Defecography, first described by Burhenne in 1964, is increasingly being used for preoperative evaluation of pelvic organ prolapse. Defecography is believed useful by some because it provides objective outcomes and identifies anatomic abnormalities. […] Defecography is a good diagnostic tool to help exclude other defecation disorders that may increase the risk of recurrence of symptoms despite anatomic repair. […] Scintigraphic defecography is another tool to evaluate the physiology of rectal emptying. […] Electromyography and nerve conduction studies also have been used to evaluate defecation disorders. […] When the clinical diagnosis is made, potentially confirmed by ancillary studies, the decision to operate or to treat conservatively must be made. […] The only nonsurgical therapy available for prolapse symptoms is estrogen replacement therapy in postmenopausal patients and the use of a vaginal pessary.

• #24 Rectocele Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/268546-workup

  In women with defecatory dysfunction, a gastrointestinal evaluation, including a barium enema or colonoscopy, is recommended to eliminate colorectal malignancy from the differential diagnosis. Anoscopy may reveal anorectal pathology such as prolapsing hemorrhoids, and proctosigmoidoscopy helps to exclude intrarectal prolapse or a solitary rectal ulcer. Occasionally, referring the patient to an anorectal physiology laboratory may be necessary. This may be necessary to differentiate between patients with colonic motility disorders and those with predominant pelvic outlet symptoms. […] Rectoceles are commonly found on proctograms, and small bulges of the anterior rectal wall detected upon evacuation proctography might be normal findings because they are frequently asymptomatic. Rectoceles should be considered abnormal if barium trapping (the rectocele does not completely empty upon evacuation) is noted.

• #24 Rectocele Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/268546-workup

  Consider performing ancillary testing to ensure the patient has been evaluated for other types of pelvic floor dysfunction. The tests usually considered are physiological tests of bladder and rectal function and imaging tests to clarify anatomical derangements. It is critical to also evaluate all pelvic supports of the vagina including apical and anterior to rule out concurrent defects, as they may often coexist with rectoceles, in order to properly plan surgical repair of all defects. Urodynamic testing is commonly used for patients considering surgical repair with urinary incontinence or symptoms of voiding dysfunction in addition to pelvic organ prolapse, although the benefit of urodynamic testing in women without urinary incontinence is controversial. Urodynamic testing with reduction of the vaginal wall prolapse is recommended in patients with an equivocal diagnosis. Similarly, anorectal physiologic testing may be useful in patients with suspected anismus or concurrent fecal incontinence. The most important consideration in a patient with rectocele is the presenting symptoms. In women with isolated herniation symptoms consistent with rectocele, further testing is probably not required.

• #25 The Pathophysiology, Diagnosis, and Management of Rectoceles | GLOWM

  https://www.glowm.com/section-view/heading/The%20Pathophysiology,%20Diagnosis,%20and%20Management%20of%20Rectoceles/item/58

  Defecography is believed useful by some because it provides objective outcomes and identifies anatomic abnormalities. […] Defecography is a good diagnostic tool to help exclude other defecation disorders that may increase the risk of recurrence of symptoms despite anatomic repair. […] Significant rectoceles tend to trap barium during defecography. […] When the clinical diagnosis is made, potentially confirmed by ancillary studies, the decision to operate or to treat conservatively must be made. […] Indications for surgery should include severe symptoms, the presence of an anatomic defect, or the need for other pelvic reconstructive surgery with an asymptomatic rectocele. […] The colorectal literature noted that defecography showing a rectocele greater than or equal to 20 mm with symptoms is a good indicator for surgery; however, this finding has not been conclusive in all studies.

• #26 The Pathophysiology, Diagnosis, and Management of Rectoceles | GLOWM

  https://www.glowm.com/section-view/heading/The-Pathophysiology-Diagnosis-and-Management-of-Rectoceles/item/58

  Symptoms that predict good postoperative results include pelvic pressure and a vaginal bulge, vaginal digitalization or splinting (which occurs in 20-75% of symptomatic patients), and outlet obstruction constipation. […] The colorectal literature noted that defecography showing a rectocele greater than or equal to 20 mm with symptoms is a good indicator for surgery; however, this finding has not been conclusive in all studies. […] Signs and symptoms that are predictive of a poor surgical outcome include a history of potent laxative use, incidence of preoperative pain, and large-volume rectoceles in women who previously had undergone hysterectomy. […] Three different surgical techniques currently are being used to repair symptomatic rectoceles: levator plication, site-specific repair, and transanal and transabdominal repairs. […] Due to the high anatomic and functional success rates (82%) of site-specific rectocele repairs, it is difficult to universally recommend posterior compartment graft augmentation.

• #27 Rectocele Fort Lauderdale, FL | Posterior Vaginal Prolapse Miami, FL

  https://www.urogyne.net/rectocele-urogynecologist-fort-lauderdale-miami-boca-raton-fl.html

  A rectocele or posterior vaginal prolapse is the bulging of the rectum into the vagina due to the weakening of the rectovaginal septum and pelvic floor muscles. […] Your doctor will diagnose a rectocele on pelvic exam, but may require radiologic tests such as an MRI in order to confirm an internal finding. […] Before planning a surgical repair, we may order one or both of the following tests: Bladder function testing (Urodynamics): This tests the ability of your bladder to store and eliminate urine. […] Urinalysis: To make sure there is no UTI, blood in the urine, or other abnormalities.

• #28 Rectocele Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/268546-workup

  Pelvic floor fluoroscopy is considered the criterion standard for measuring perineal descent and is more accurate than physical examination for defining which organ is herniating into the vagina. However, it is usually reserved for patients with marked defecatory dysfunction. […] Dynamic magnetic resonance imaging provides a similar evaluation. It also provides multiplanar information about the soft tissues of the pelvic floor. The most appropriate use of this test is for patients with complex pelvic organ prolapse or symptoms that are not explained by the physical examination findings. […] Anismus can mimic the defecatory symptoms of posterior pelvic organ prolapse and can cause posterior pelvic organ prolapse as a result of outlet obstruction. This should remain a consideration in the differential diagnosis. Anismus is usually suspected in patients with tender, hypercontracted puborectalis muscles upon bimanual examination, especially if she cannot relax these muscles on command. Pelvic floor fluoroscopy can provide evidence of anismus, including lack of straightening of the anorectal angle and failure to evacuate two thirds of contrast after 30 seconds of straining. However, a balloon expulsion test and surface electromyography are considered superior for making the diagnosis of anismus.

• #29 Rectocele | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/rectocele

  Some of the causes of a rectocele include vaginal childbirth, hysterectomy, pelvic surgery and chronic constipation. […] A rectocele may occur by itself or present alongside other pelvic abnormalities, such as a prolapsed bladder (cystocele). […] Surgery may be needed if the rectocele doesnt respond to simpler treatments. […] A doctor can diagnose rectocele by using a number of tests including pelvic examination and special x-ray (proctogram or defaecagram).

• #30 Posterior vaginal prolapse (rectocele) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectocele/symptoms-causes/syc-20353414

  Sometimes, posterior vaginal prolapse doesn’t cause problems. But moderate or severe posterior vaginal prolapses might be uncomfortable. See a health care provider if your symptoms affect your day-to-day life. […] Posterior vaginal prolapse results from pressure on the pelvic floor or trauma. […] A surgeon can evaluate the prolapse and talk about options for surgery to fix it.

• #31 Symptoms & Types – Voices for PFD

  https://www.voicesforpfd.org/pelvic-organ-prolapse/symptoms-types/

  Although some women with POP have no symptoms, others may experience: […] This type of prolapse occurs when there is a loss of support to the back wall of the vagina. With this loss of support, the rectum or intestines drops down and vaginal tissue may bulge from the opening. Symptoms typically include: […] Problems having a bowel movement. […] The need to put your finger in or around the vagina or rectum to help empty bowels.

• #32 Posterior Vaginal Prolapse (Rectocele) – Types, Symptoms and Treatment | Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/posterior-vaginal-prolapse-rectocele-types-symptoms-and-treatment

  Posterior vaginal prolapse (rectocele) is a medical condition that occurs when the muscles and ligaments in your pelvic region become weak. […] Signs and symptoms of posterior vaginal prolapse (rectocele) may vary from person to person. The common symptoms commonly include: A slight bulge of tissue protruding through the vaginal opening, Feeling a sensation of fullness or rectal pressure, Difficulty during bowel movements, Feeling that your bowels have not been completely emptied, A sense of looseness in the vaginal tissues during sexual intercourse. […] Posterior vaginal prolapse (rectocele) is a common condition. Sometimes, women who have not given birth may also experience posterior vaginal prolapse (rectocele). […] Depending on the severity of the posterior vaginal prolapse (rectocele), the doctor may recommend the treatment plan.

• #33 Rectocele | healthdirect

  https://www.healthdirect.gov.au/rectocele

  A rectocele (also known as a 'posterior vaginal prolapse’) is a type of pelvic organ prolapse. Prolapse means that something has 'fallen out of place’. […] A rectocele occurs when the wall between the rectum (where faeces are stored) and the vagina becomes weak. This allows part of the rectum to bulge into the vaginal area. […] If you are experiencing any symptoms of a rectocele, you should see your doctor. Early treatment can help reduce the severity of the prolapse. […] Your doctor will ask you about your symptoms and how they affect your daily life. Your doctor will also examine you. […] Your doctor might refer you for an ultrasound or to a specialist such as a gynaecologist (a doctor who manages conditions that affect the female reproductive system). […] Treatment will depend on the severity of the rectocele. It may get worse over time if not treated. […] If your symptoms can’t be managed by pelvic floor exercise and diet, your doctor may recommend surgery to strengthen your vaginal wall.

• #34 Posterior Vaginal Prolapse – Symptoms | Causes | Diagnosis | Treatment | Complications | Prevention

  https://www.icliniq.com/articles/womens-health/posterior-vaginal-prolapse

  Based on the severity of the symptoms the most appropriate treatment is recommended for rectocele. […] Moderate to severe cases are treated with a vaginal pessary (a support device that is inserted into the vagina) or rectocele repair, which is a minimally invasive surgical procedure. […] The following issues occur if a rectocele is left untreated: – Pressure or discomfort in the pelvic area. – Constipation. – Leakage of bowel movements or bowel incontinence. – Sexual dysfunction. […] The rectocele may be so slight that one cannot feel it. If the prolapse is more severe, it may feel like a bulge or lump in the back wall of the vagina. […] A posterior repair is a major surgery, which is usually recommended after trying out the simpler treatments.

• #35 Posterior Vaginal Prolapse (Rectocele) – Types, Symptoms and Treatment | Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/posterior-vaginal-prolapse-rectocele-types-symptoms-and-treatment

  Posterior vaginal prolapse (rectocele) is a common medical condition. Although mild cases may not cause any signs and symptoms, severe cases may experience extreme discomfort. […] If left untreated, posterior vaginal prolapse (rectocele) can cause the following complications: Constipation, Constant pressure and discomfort in the pelvic region, Leakage of bowel contents through the vagina, also known as faecal incontinence. […] Since posterior vaginal prolapse (rectocele) is an anatomical defect, it cannot be fixed naturally. Its treatment depends on the severity of the symptoms. A surgical approach is a definitive treatment for it.

• #36 Rectocele – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546689/

  Rectoceles may be benign but have enormous morbidity. […] The disorder is underdiagnosed and undertreated. […] For this reason, management is best when performed by an interprofessional team. […] Rectoceles are not well studied because many patients are either asymptomatic or do not seek care for their symptoms.

• #37 Rectocele – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK546689/

  The severity of the patient’s symptomatology dictates the management approach to rectocele. […] Surgical management is reserved for those with obstructive defecatory symptoms and bothersome symptoms who have failed other forms of treatment. […] The principle of the surgical treatment is posterior vaginal wall or fibromuscular tissue repair or plication to strengthen the tissue and reduce the prolapsing rectum through the posterior vaginal wall. […] There is no consensus on the best approach or the best surgical repair for treating rectoceles. […] Rectoceles may be benign but have enormous morbidity. The disorder is underdiagnosed and undertreated. […] For this reason, management is best when performed by an interprofessional team.

• #38

  https://continentalhospitals.com/diseases/posterior-vaginal-prolapse/

  Posterior vaginal prolapse, also known as rectocele, is a common condition that affects many women. It occurs when the wall of the vagina weakens or stretches, causing the rectum to bulge into the vaginal space. […] Understanding what posterior vaginal prolapse is can help individuals recognize its symptoms and seek appropriate medical attention. […] If you notice symptoms such as a bulging sensation or pressure in the vaginal area, it’s crucial to consult with a Gynecologist to assess and address potential concerns related to posterior vaginal prolapse. […] Diagnosing posterior vaginal prolapse is a crucial step in providing appropriate treatment and care for individuals experiencing this condition. Healthcare professionals employ various methods to accurately diagnose posterior vaginal prolapse, ensuring an effective management plan is put in place. […] A healthcare professional can diagnose posterior vaginal prolapse through a physical examination that may involve assessing your medical history, performing a pelvic exam while you bear down or strain, and potentially using imaging tests like ultrasound or MRI for further evaluation.

• #39 Rectocele Symptoms | Comprehensive Guide at Restore Your Core

  https://restoreyourcore.com/learn/prolapse/rectocele-symptoms/

  Rectocele is a condition which causes the supportive tissues between the rectum and the vagina to weaken. This can occur due to excess pressure in the rectum, excess vaginal pressure, or excess intra-abdominal pressure leading to pelvic floor issues such as pelvic organ prolapse (POP). When this occurs, the separating tissues can herniate causing the front wall of the rectum to bulge into the vagina. This issue is also commonly called a posterior vaginal prolapse. Oftentimes, the prolapse is small and does not pose any painful symptoms or difficulties. However, in severe cases, the bulge may manifest outside of the vaginal opening and require surgical repair. […] If you are experiencing severe issues such as: tissue bulging through your vaginal opening or constant struggles with constipation, it may be time to consult your doctor for a proper diagnosis. Generally a Urogyn is the best bet for diagnosis.

• #40 Bowel Dysfunction –

  https://urogynaecology.com.au/bowel-dysfunction/

  Constipation is related to prolonged and slow transit of the faeces through the bowel and is not caused by vaginal prolapse. […] Women undergoing prolapse surgery should understand the importance of correcting and managing the constipation to decrease the risk of recurrence of the vaginal prolapse. […] Women with obstructed defecation (incomplete evacuation or those using digital pressure to assist in evacuation of their bowel) with a rectocele should be managed as per the POP surgical guideline. […] Those with obstructed defecation without rectocele should be investigated to exclude rectal prolapse. […] Women with faecal incontinence require colorectal diagnostics as discussed above and those with rectal prolapse as a cause may require combined gynaecology and colorectal surgery. […] Women with vaginal prolapse and constipation should understand the prolapse is likely to be at least partially caused by the constipation. […] The constipation will not be resolved by the prolapse surgery. […] Ongoing post-operative management of constipation is required to minimise the risk of prolapse recurrence.

• #41 How to Self-Check for Pelvic Organ Prolapse

  https://www.theoriginway.com/blog/how-to-self-check-for-pelvic-organ-prolapse-and-what-to-do-next

  Pelvic organ prolapse occurs when the muscles and connective tissues in your pelvic floor including those surrounding your vagina become too damaged and weak to support your pelvic organs, causing an organ (or part of an organ) to drop down into the vaginal canal or rectum. […] Posterior Prolapse involves the displacement of the organs from the backside of the vaginal vault and includes the rectum (rectocele), it’s referred to as a posterior prolapse. […] If you think you might have pelvic organ prolapse or have already been diagnosed and want to start feeling better see a pelvic floor physical therapist sooner rather than later. […] Physical therapy treatment for vaginal or pelvic organ prolapse usually involves assessing and optimizing the performance of your pelvic floor, hip, and abdominal muscles.

• #42 Pelvic Organ Prolapse | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0801/p179.html

  The need for additional evaluation depends on patient symptoms, stage of prolapse, and the proposed treatment plan. […] The primary goal of any treatment is to improve symptoms and, for conservative management, to minimize prolapse progression. […] Most cases of pelvic organ prolapse do not require treatment; however, women with prolapse beyond the vaginal opening typically desire some intervention. […] Pessaries are devices that are placed in the vagina to restore normal pelvic anatomy and decrease prolapse symptoms. […] Women who require more advanced evaluation and treatment should be referred to a gynecologic subspecialist with board certification in female pelvic medicine and reconstructive surgery. […] Obliterative and reconstructive surgeries for pelvic organ prolapse are available and may include hysterectomy or uterine conservation (hysteropexy).

• #43 Pelvic organ prolapse in women: Diagnostic evaluation – UpToDate

  https://www.uptodate.com/contents/pelvic-organ-prolapse-in-women-diagnostic-evaluation

  Pelvic organ prolapse (POP), the herniation of the pelvic organs to or beyond the vaginal walls, occurs in up to 50 percent of parous women and causes a variety of pelvic, urinary, bowel, and sexual symptoms. POP stage is diagnosed on pelvic examination. A medical history is also important to elicit commonly associated symptoms since treatment of urinary or fecal symptoms is typically coordinated with treatment for POP. Asymptomatic POP may not require treatment. […] The diagnostic evaluation of women with POP is reviewed here.

• #44 Posterior vaginal prolapse (rectocele)

  http://ask-ahd.ahdubai.com/con-20314570

  Treatment depends on the severity of the posterior vaginal prolapse. Your doctor might recommend: Observation. If your posterior vaginal prolapse causes few or no symptoms, simple self-care measures such as performing Kegel exercises to strengthen your pelvic muscles may provide relief. […] Surgical repair might be needed if: The posterior vaginal prolapse protrudes outside your vagina and is especially bothersome. […] Kegel exercises strengthen your pelvic floor muscles. A strong pelvic floor provides better support for your pelvic organs, prevents prolapse from worsening and relieves symptoms associated with posterior vaginal prolapse.

• #45 Rectocele Atlanta | Posterior Repair | Pelvic Organ Prolapse

  https://www.miklosandmoore.com/uterine-prolapse-surgery-atlanta/rectocele/

  A rectocele is a defect in the support system of the floor of the vagina. […] A rectocele is a defect in the support system (i.e. rectovaginal fascia) of the floor of the vagina and usually presents as bulge in the vagina. […] When a womans rectocele is large enough she may suffer from symptoms including: vaginal pressure, vaginal bulge, difficulty evacuating her rectum, constipation, loose stools, or painful intercourse. […] The Posterior Repair is the most commonly performed operation to repair a rectocele. […] Despite being one of the most common operations in the field of gynecology it is probably one of the most poorly understood as the rate of success is 80 % 1 year after surgery and 60% 3 years after surgery for any surgeon.

Zobacz więcej