What is the procedure Rectocele Repair?

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Rectocele Repair

Repairing the hernia of the bowels into the vagina is known as Rectocele Repair. Rectocele repair is a medical procedure performed to repair a rectocele or prolapse of the rectum. A rectocele happens when the rectum begins to fall to the front pushes against and back wall of the vagina. The rectal wall may become thin and weak and balloons into the vagina on straining or simply when walking about. In case of a rectocele, doctor may suggest a surgery to correct the condition. Women who have a rectocele may also experience the sensation of something bulging into the vagina. They may also experience trouble in bowel movement. They may even find that they must split, or insert fingers into the vagina to hold back the bulge, in order to complete a bowel movement. A rectocele may be present without any other irregularities. In some cases, a rectocele may be part of a more generalized weakness of pelvic support.


What is the reason for a rectocele to occur?

The fundamental reason for a rectocele is a weakening of the pelvic support structures and contraction of the recto vaginal septum. Several factors may increase the risk of a woman developing a rectocele. These include:

  •  Birth trauma such as multiple, difficult or prolonged deliveries.
  •  The use of forceps or other aided methods of delivery
  •  Perineal tears or an episiotomy into the rectum or anal sphincter muscles.
  •  In addition, a history of constipation and straining with bowel movements, or hysterectomy may contribute to the development of a rectocele.

Generally, these problems develop with age but they may seldom happen in younger women or in those who have not delivered children.


What are the symptoms of a rectocele?

Many women have rectoceles but only a small percentage of women have symptoms related to the rectocele. Symptoms may be mainly vaginal or rectal.
I. Vaginal symptoms include:

  •  Vaginal bulging, vaginal infection or urinary tract infection.
  •  Sensation of a mass in the vagina
  •  Pain with intercourse or even something hanging out of the vagina that may become inflamed.
  •  Sometimes, vaginal bleeding is seen, if the vaginal lining of the rectocele is irritated, however other sources of the bleeding should be checked by the doctor.

II. Rectal symptoms include:

  • Constipation especially difficult evacuation with straining. Often this is associated with bulging in the vagina when straining to have a bowel movement.
  •  A few women find that pressing against the lower back wall of the vagina or along the rim of the vagina helps to empty the rectum.
  •  Occasionally, there will be a rapid return of the urge to have a bowel movement after leaving the toilet, as the stool that was trapped in the rectocele may return to the low rectum after standing up.
  •  Often, a common feeling of pelvic pressure or uneasiness is present but this may be due to a several issues.


What are the treatments for rectocele repair?

Generally, Surgery is done only if the following treatments fail:

  • Doing muscle-strengthening exercises known as Kegel exercises.
  •  Placing a diaphragm or tampon in the vagina to support its walls.


How is the surgery performed?

  • Rectocele repair surgeries are usually done through the vagina or the perineum (the skin between the vagina and the anus). The approach that the doctor recommends will depend on the severity of the rectocele. Once the area of the rectocele is reached, surgery includes these general steps:
  • The patient will be given either general or regional anesthesia. With general anesthesia, the patient will be asleep. Regional anesthesia will numb the lower body, but the patient will be awake.
  •  A bladder catheter will be inserted in the urethra to decrease pressure on the bladder.
  • The surgeon makes one or more incisions (cuts) along the back wall of the vagina (the side closest to the rectum).
  •  Stitches are sewn into the weakened tissue around the vagina and rectum, and along the vaginal wall.
  •  The stitches can strengthen the tissues by closing any tears and by encouraging scar tissue to build in the area for extra support. Sometimes mesh or a graft material is sewn in for additional support.
  • The perineum will be repaired with deep stitches into the muscle, if necessary.
  •  The vaginal incisions are closed with stitches and the vagina may be packed with gauze.
  •  The stitches used in this surgery will eventually be absorbed by the body. So, they don’t have to be removed.
  •  The procedure may take 45 minutes to two or more hours.


What is the Post-procedure care?

  • Usually, a medicated vaginal packing is left in the vagina overnight.
  •  The bladder catheter will be removed as soon as the patient is able to use the restroom on his/her own.
  •  The patient may notice a smelly, even bloody, discharge from the vagina for 1-2 weeks
  •  At home, lifting anything that weighs more than 10 pounds, inserting anything into the vagina, such as tampons or having sexual intercourse should be avoided.
  •  The patient is advised to drink lots of fluids and eat a high fiber rich diet.
  •  It is vital to follow the doctor’s instructions after surgery.


What will be the recovery time for a rectocele repair?

Typical recovery for the procedure is 2-3 weeks. During the first week the patient will have to take pain killers which will probably make them feel exhausted and sleepy and tired.


What are the complications of the surgery?

The possible risks of the surgery are:

  •  Bleeding
  •  Infection
  •  Urinary retention
  •  Damage to bowel
  •  Pain with intercourse
  •  Difficulty with bowel movements
  •  Failure of the surgery
  •  Accidental damage to vagina, rectum, and bladder
  •  Accidental damage to nearby organs

Rare risks may be blood clot in the legs or lungs or Complications from anesthesia

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