Rectocele - is prolapse of the pelvic organs to form protrusions divertikulopodobnogo surround the rectal wall in the direction of the vagina.The complexity of this disease is not so much disturbed relationship between the structures of the perineum, as in violation of the basic evacuation function of the colon in the form of intestinal evacuation of stool.
intensity of clinical manifestations has a correlation dependence on the rectal wall prolapse.According to statistical indicators rectocele incidence among women has increased considerably, and most patients make a woman giving birth.Among men, this disorder affects only patients who have been a steady increase in intra-abdominal pressure that occurs when one or other pathology of the abdominal cavity.
most common etiopathogenetic link in the development of rectocele is stretching and weakening of the musculo-ligamentous apparatus of the vagina that occurs during childbearing and delivery time.Multiple p
There are also a variety of pathological conditions, each of which does not cause the development of rectocele, but in aggregate are predisposing factors to its development (dysfunction of the colon due to prolonged episodes of constipation, weakness musculo-ligamentous frame the pelvic congenital genesis, the functions of the external sphincter, overweight and continuous heavy physical activity).
Symptoms of rectocele
clinical picture rectocele develops very slowly and is not accompanied by the development of symptoms, the patient's life-threatening, so a tendency to late treatment of women to the proctologist medical advice, where the effectiveness of the conservative part of the treatment is very low.There are a number of clinical criteria, which suggests the presence of rectocele at a particular patient (tendency to constipation, feeling the presence of the bulk of education in the crotch area, pain in the perianal and rectal bleeding).
initial manifestations of this disease is a violation of the regularity of the act of defecation and the appearance of the patient feeling of incomplete emptying even after defecation.In this situation, the majority of patients resort to frequent use of drugs that have a laxative effect, thus exacerbating the underlying pathology for.
When rectocele 2 degrees when the protrusion of the rectum reaches significant parameters, in order to facilitate the state of women "pressed stool" in the intestines through the rear surface of the vagina.
part of "companion" rectocele is the development of hemorrhoids, anal fissures, and abscess, which, in fact, are the main complications of disease and significantly worsen its course.In some cases, grade 3 rectocele is accompanied by episodes of vaginal bleeding due to additional irritation of the vaginal mucosa.
stagnation of feces in the diverticulum of the rectum causes the development of inflammatory changes involving expanded clinical symptom (fever of a hectic type, severe pain in the perineum, intoxication syndrome).
Rectocele rectum is classified as slowly progressive surgical pathologies, the development of which takes a long period of time.Depending on the prevalence of various pathological changes in the projection of the pelvic organs, secrete several degrees of rectocele.
Diagnosis "rectocele 1 degree" can be set as a random finding during a routine examination of the patient, including a visit to the proctologist and digital rectal examination.This category of patient (s) approx makes no claims on change of bowel function and pathological changes of the rectal wall are minimal.
developed clinical symptoms of rectocele occurs at 2 degrees, when the majority of patients has specific complaints about the inability to completely empty the bowel and constant discomfort in the perianal region.An objective examination of the patient is easy enough to detect a significant prolapse of the rectum up to the vestibule, which indicates the progression of pathological disorders.
grade 3 rectocele is critical, which is significantly reduced quality of life for patients.In this situation, women experience constant discomfort in the projection of the pelvis and the perineum and sometimes severe pain.Visual signs rectocele is to detect not only a bulging wall of the rectum and the vagina below the genital slit.Depending on which of the walls of the rectum prolapses, stands out front or rear version of rectocele.
There is also an anatomical classification of rectocele, in which divided three types of the disease.The most favorable is the low rectocele, in which marked dysfunction of the sphincter of the rectum, occurs usually as a result of heavy delivery.In the development of high rectocele is fundamental tension ligamentous apparatus of the uterus and vagina, in which there was a complete loss of internal genitalia, and sometimes small bowel (enterocele).
In addition, there is a rectocele diagnostic classification based on the results of ray imaging techniques, according to which the protrusion of up to 20 mm is regarded as the minimum, and a critical indicator is the size of 40 mm or more.
Despite the fact that the most effective in the treatment of rectocele has surgery, conservative methods in some situations allow the best to prepare the patient for surgery.The main objective of Conservative therapy is to improve the motor-evacuation function of the large intestine, which is set in the postoperative rehabilitation period.
preoperative conservative treatment is advisable to carry out a period of not less than two months before the intended date of operation and the regimen should include a range of therapeutic interventions and drug-free medical direction.Equally important in the rectocele correction and prevention of further progression of the disease is the correction of eating behavior of the patient, is to enrich the daily diet products containing a high concentration of fiber, has a beneficial effect on improving motility of the large intestine.
In a situation where the diagnosis is the patient at the initial stage of rectocele, has good efficiency performance of a complex physical therapy and physiotherapy techniques directions.Exercises at rectocele designed to strengthen the pelvic floor muscular frame, and therefore, the conditions to prevent further progression of the disease.
Drug therapy component rectocele presented osmotic laxatives actions eubiotics and prokinetic.Laxatives osmotic action have a number of advantages that allow them to use an extended period of time as a symptomatic drug (Forlaks 1 package of 10 mg orally in the morning), but the main advantage of this category of drugs is their safety during the childbearing and lactation.Note that prolonged use of osmotic laxatives may be accompanied by the syndrome of dehydration, which is an absolute indication for discontinuation.
Eubioticheskie appropriate to prescribe drugs at any stage of rectocele, since these drugs have a positive effect on the digestion of food substrate in the intestines, prevent the fermentation process and contribute to the formation of normal stool consistency.When rectocele should give preference combined eubiotics, a part of which contains therapeutic concentration of bifidobacteria and lactobacilli (Linex 2 capsules three times daily after meals).Observe storage mode this category of drugs (ambient temperature 4-7 degrees Celsius), since components of the formulation are sensitive to elevated temperatures.
stimulating effect on the process of moving stool through the bowel and emptying the rectum have prokinetic drugs (Motillium 10 mg 3 times a day orally).
Surgery for rectocele
Surgical treatment is the only reasonable method of pathogenetic correction of rectocele, as surgical removal of the defect is not symptomatic method, and radical.All methods of surgical correction should be divided into two main groups: immediate removal of prolapse of the rectal wall and strengthening the muscular frame between the rectum and the vagina.
Depending on the degree of prolapse of the rectal wall and localization bulging, operational manual can be carried out through the vaginal, rectal and transabdominal access under epidural anesthesia.Surgery is carried out by performing successive manipulations in a plot to eliminate prolabiruemogo rectum with subsequent fixation of the rectum on the front wall, strengthening rectovaginal muscular frame and adjust the external sphincter.Closure walls of the colon is recommended in conjunction with the muscle fibers, raises the anus, thereby strengthening the rectovaginal septum.
In some situations, when there is an extreme degree of rectocele with concomitant surgical complications in the form of loss of hemorrhoids, the presence of bleeding from anal fissures, as well as features available pararectal fistula, recommended a one-time surgical removal of the defects described above, together with the operational benefits of rectocele.
most modern and acceptable method of surgical correction of rectocele is currently installing an implant mesh type endoscopic method, which is considered a minimally invasive surgery, devoid of postoperative complications.Due to the fact that the implant is made of high quality material, patients does not cause problems with adaptability extraneous tissue and no allergic component.
Like any other surgery, surgical treatment of rectocele has some absolute contraindications that limit its use (a severe form of a chronic pathology of the patient, which may be accompanied by the development of life-threatening conditions of the patient).In this situation, a woman should always be wearing a pessary, warning further progression of the disease and the loss of internal genital organs from the vagina.