Rectocele - Enterocele

It refers to a prolapse of the posterior wall of the vagina due to bulging of the rectum forward toward the vagina.

What is rectocele and enterocele?

The pelvic organs (the organs in the pelvis in the inguinal region) include vagina, uterus, urinary bladder, and intestines. The pelvic floor muscles and connective tissues support these organs and prevent them from herniating into the vagina. When the pelvic floor muscles and the connective tissues become weak, herniation of the large intestines into vagina is called rectocele, and herniation of the small intestines into vagina is called enterocele.

What are the causes of rectocele and enterocele?

Pregnancy and delivery are the most important causes of weakened pelvic floor. Delivering babies with higher birth weight, interventional delivery like vacuum/forceps, or extended duration of delivery increase the risk. High number of deliveries also increases the risk of herniation of the intestines into vagina. In other words, the more deliveries you have the higher is the risk for you.
Enterocele/rectocele might be seen due to weakening of the pelvic floor supportive tissues due to reduction in the hormones, which is caused by aging and menopause. Chronic constipation, asthma, smoking, obesity, and genetic predisposition are some of the other causes of enterocele/rectocele.

At what ages are rectocele and enterocele observed?

It can be observed at any age; however, the symptoms are most frequently seen after menopause.

What are the symptoms of rectocele and enterocele?

Depending on severity of the disease, it can vary from the sense of fullness and pressure in the lower stomach region to palpable mass prolapsing from vagina. Such patient might have symptoms such as chronic constipation, anal incontinence, defecating by pressing with finger through the vagina, and discomfort in sexual intercourse due to vaginal loosening.

How are they treated?

Light cases without any complaint generally do not require treatment. In the cases with constipation, the symptoms can be regressed by eating fibrous foods and increasing fluid intake. Surgery may be suggested depending on sexual activity, degree of the prolapse, and severity of the symptoms. During the operation, the prolapsing intestines are hung back on their former places. The weakened vaginal tissue is strengthened and the vagina is tightened to a certain extend.

Does rectocele/enterocele recur after the operation?

There is a risk of recurrence for rectocele/enterocele depending on being younger than 60, being overweight, existence of severe prolapse before the first operation, and the technique of the operation.