Rectocele repair

Overview

A rectocele occurs when the front wall of the rectum protrudes into the posterior wall of the vagina due to the band of tissue between the two structures becoming thinner and less strong. Causes of this weakening include factors such as age, multiple vaginal childbirths, trauma during delivery, pelvic floor or rectal surgeries, and chronic straining during bowel movements from constipation.

In many cases, rectocele may not present noticeable symptoms and might only be detected during pelvic examinations. When symptoms do arise, they can include difficulty with bowel movements, a feeling of vaginal bulging or fullness, sexual intercourse problems, and the need to manually reduce the bulge to aid bowel movements.

Treatment is typically recommended only if symptoms significantly affect quality of life.

Types of rectocele repair surgeries

If conservative methods fail to alleviate rectocele symptoms, surgical intervention may be necessary. Consulting with a reconstructive surgeon specializing in pelvic floor conditions can assist women in determining the most appropriate course of action. Typically performed under general anesthesia, the surgery typically lasts approximately one hour.

The most common surgical technique is transvaginal rectocele repair, also known as posterior repair, where access to the rectocele is achieved through the vagina. This procedure not only addresses the rectocele but also addresses issues like a thinned perineum and widened vaginal opening. It avoids disturbance to tissue in the rectal region. Both urologists and gynecologists commonly use this traditional approach for rectocele repair.

Alternatively, a colorectal surgeon can perform rectocele repair through a transanal approach, accessing the rectocele via the anus. This method is preferred by many colorectal surgeons as it enables correction of issues in the anal or rectal area alongside rectocele repair.

In cases where additional procedures are necessary, such as for uterine or bladder prolapse (cystocele) or rectal prolapse through the anus, alternative repair methods or approaches may be employed.

Risks

Surgical rectocele repair carries the following risks:

• Infection
• Bleeding
• Pain experienced during sex
• The rectocele recurrence
• The formation of an open channel, or fistula, connecting the rectum and vagina

Before the procedure

Your healthcare provider will provide instructions on preparing for the surgery. Adhering closely to their guidance can minimize the risk of complications.

Prior to a rectocele repair, your provider may advise you to undergo blood or urine tests, fast for six to eight hours before the procedure, adjust medication intake as instructed (without discontinuing unless advised), take stool softeners or complete additional bowel preparation, and arrange for transportation home post-surgery (as rectocele repair typically necessitates at least one overnight hospital stay).

During the procedure

During rectocele repair, a healthcare provider will:

• Administer general anesthesia.
• Administer antibiotics intravenously.
• Make an incision in the back wall of your vagina (transvaginal, transanal, or transperineal).
• Insert a catheter to drain urine.
• Use sutures or alternative methods to reinforce ligaments and fortify tissue between the vagina and rectum (mesh is typically not recommended).
• Address any additional concerns such as perineal thinning or other displaced tissue areas (prolapse).
• Close the incisions.

Rectocele repair surgery typically lasts about an hour.

After the procedure

Following rectocele repair, you’ll typically recover in the hospital for one to three days. Upon discharge, a healthcare provider will remove your catheter, prescribe pain medications with instructions on usage, provide guidance on self-care during recovery, and advise that someone drives you home from the hospital.

Outcome

Several factors influence the degree of success following rectocele repair, such as:

• The type of the symptoms.
• The duration of the symptoms’ occurrence.
• The surgical technique and approach used.

Research indicates that between 75% and 90% of patients have meaningful improvement; nevertheless, with time, patient satisfaction declines.