at Pierpaolo Sileri
It can cause pain and a sense of perineal weight, abdominal discomfort, urinary problems and sexual problems, such as vaginal pain during intercourse
I am 50 years old and I suffer from constipation. The gynecologist told me I have a rectocele. Could this be the cause of my constipation?
Answered by Pierpaolo Sileri, director of the Coloproctological Surgery Unit, chronic intestinal diseases, San Raffaele Hospital, Milan
The rectocele is a weakening of the wall between the vagina and rectum, which therefore takes on the shape of a pocket of variable dimensions. A rectocele does not always lead to constipation, but when feces reach this pocket during defecation, complete evacuation may not be achieved, pain and a sense of perineal weight may be felt, as well as abdominal discomfort. These may be associated with urinary and sexual problems, such as vaginal pain during intercourse. These are symptoms that appear quietly, usually after the age of 40, and become more evident after the age of 50. Age is the greatest risk factor and a certain degree of natural tissue relaxation. Number of pregnancies, body weight (overweight, but also rapid and lasting weight loss), physical effort, removal of the uterus are other factors to consider.
The diagnosis
There may also be a genetic predisposition. A history of chronic constipation from a young age can contribute, due to continuous effort, to the formation of the rectocele. Returning to the specific case, the diagnosis of the rectocele was made with a gynecological examination, but to understand if there are other anatomical defects and how much the pouch interferes with defecation, a visit to the colorectal surgeon and a defecographic examination will be needed to evaluate the coexistence of other defects anatomy of the rectum and pelvic floor. Defecography, or rather colpocystodefecography, through contrast media in the rectum, vagina and bladder can provide information on anatomical defects (extent of prolapses, presence of cystocele, enterocele, colpocele, laxity of the pelvic floor, muscular incoordination). The diagnostic accuracy allows for the most personalized treatment possible. Surgery is not always necessary.
The treatment
If there is muscular incoordination, the first treatment will be rehabilitative gymnastics. If there is a correlation between the anatomical defect and severe constipation, the operation will be performed. If it is a rectal prolapse with rectocele and prolapse of other structures, such as the uterus or bladder, a minimally invasive abdominal operation will be decided. These interventions are conducted in reference centers robotically with greater precision, fewer complications and fast recovery. When faced with a small rectocele, transanal surgery is preferred to remove the pocket and the prolapse.
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January 18, 2024 (changed January 18, 2024 | 07:17)
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