WordNet

protrusion or herniation of the rectum into the vagina; can occur if pelvic muscles are weakened by childbirth (同)proctocele

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/16 02:32:01」(JST)

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A rectocele (/ˈrɛktəsiːl/ REK-tə-seel) results from a tear in the rectovaginal septum (which is normally a tough, fibrous, sheet-like divider between the rectum and vagina). Rectal tissue bulges through this tear and into the vagina as a hernia. There are two main causes of this tear: childbirth, and hysterectomy.

Although the term applies most usually to the phenomenon of rectal herniation into the vagina in females, males may suffer with a condition likewise named. Rectoceles in men are uncommon, and usually the protrusion is backwards rather than forwards, as the prostate gland provides structural support anteriorly in men. Prostatectomy appears to be associated with rectoceles in men.^[1]

Symptoms

Mild cases may simply produce a sense of pressure or protrusion within the vagina, and the occasional feeling that the rectum has not been completely emptied after a bowel movement. Moderate cases may involve difficulty passing stool (because the attempt to evacuate pushes the stool into the rectocele instead of out through the anus), discomfort or pain during evacuation or intercourse, constipation, and a general sensation that something is "falling down" or "falling out" within the pelvis. Severe cases may cause vaginal bleeding, intermittent fecal incontinence, or even the prolapse of the bulge through the mouth of the vagina, or rectal prolapse through the anus. Digital evacuation, or, manual pushing, on the posterior wall of the vagina helps to aid in bowel movement in a majority of cases of rectocele. Rectocele can be a cause of symptoms of obstructed defecation.^[2]

Causes

It can be caused by many factors, but the most common is childbirth, especially with babies over nine pounds in weight, or rapid births. The use of forceps is more likely a marker for the vaginal injury, than a direct cause of the tear. Episiotomy or lower vaginal tears play little role in the formation of a cystocele, but may in rectoceles. The risk increases with the number of vaginal births, although it can also happen in women who have never borne a child.

A hysterectomy or other pelvic surgery can be a cause,^[3] as can chronic constipation and straining to pass bowel movements. It is more common in older women than in younger ones; estrogen which helps to keep the pelvic tissues elastic decreases after menopause.

Defecating proctogram of female showing rectocele, a possible cause of obstructed defecation and/or incomplete evacuation

Treatment

Treatment depends on the severity of the problem, and may include non-surgical methods such as changes in diet (increase in fiber and water intake), pelvic floor exercises such as Kegel exercises, use of stool softeners, hormone replacement therapy for post-menopausal women and insertion of a pessary into the vagina.^[4] A high fiber diet, consisting of 25-30 grams of fiber daily, as well as increased water intake (typically 6-8 glasses daily), help to avoid constipation and straining with bowel movements, and can relieve symptoms of rectocele.^[5]

Surgery to correct rectocele should only be considered when symptoms continue despite the use of non-surgical management, and are significant enough to interfere with activities of daily living.^[5] It is usually done by posterior colporrhaphy, which involves suturing of vaginal tissue. Surgery may also involve insertion of a supporting mesh (that is, a patch).^[5] There are also surgical techniques directed at repairing or strengthening the rectovaginal septum, rather than simple excision or plication of vaginal skin which provides no support. Both gynecologists and colorectal surgeons can address this problem.^[5] Potential complications of surgical correction of a rectocele include bleeding, infection, dyspareunia (pain during intercourse), as well as recurrence or even worsening of the rectocele symptoms.^[5] Synthetic or biologic grafts should not be used in rectocele repairs. ^[6]

References

^ Chen, HH; Iroatulam, A; Alabaz, O; Weiss, EG; Nogueras, JJ; Wexner, SD (December 2001). "Associations of defecography and physiologic findings in male patients with rectocele.". Techniques in coloproctology 5 (3): 157–61. doi:10.1007/s101510100018. PMID 11875683.
^ Wexner, edited by Andrew P. Zbar, Steven D. (2010). Coloproctology. New York: Springer. ISBN 978-1-84882-755-4.
^ "Rectocele: Risk factors - MayoClinic.com". Retrieved 2007-11-21.
^ Paraiso MF, Barber MD, Muir TW, Walters MD (2006). "Rectocele repair: a randomized trial of three surgical techniques including graft augmentation". Am. J. Obstet. Gynecol. 195 (6): 1762–71. doi:10.1016/j.ajog.2006.07.026. PMID 17132479.
^ ^a ^b ^c ^d ^e Rectocele, by Jennifer Speranza, MD at American Society of Colorectal Surgeons. Reviewed 2012
^ American Urogynecologic Society (May 5, 2015), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American Urogynecologic Society), retrieved June 1, 2015 , which cites:
- Maher, C; Feiner, B; Baessler, K; Schmid, C (30 April 2013). "Surgical management of pelvic organ prolapse in women.". The Cochrane database of systematic reviews 4: CD004014. PMID 23633316.
- Paraiso, MF; Barber, MD; Muir, TW; Walters, MD (December 2006). "Rectocele repair: a randomized trial of three surgical techniques including graft augmentation.". American journal of obstetrics and gynecology 195 (6): 1762–71. PMID 17132479.
- Sung, VW; Rardin, CR; Raker, CA; Lasala, CA; Myers, DL (January 2012). "Porcine subintestinal submucosal graft augmentation for rectocele repair: a randomized controlled trial.". Obstetrics and gynecology 119 (1): 125–33. PMID 22183220.

Rectocele details, description, video (in Russia)

UpToDate Contents

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1. 膣後壁欠損の臨床症状、診断、および非外科的マネージメント clinical manifestations diagnosis and nonsurgical management of posterior vaginal defects
2. 膣後壁欠損の外科的マネージメント surgical management of posterior vaginal defects
3. 直腸脱の概要 overview of rectal procidentia rectal prolapse
4. 女性の骨盤臓器脱：診断的評価 pelvic organ prolapse in women diagnostic evaluation
5. 女性における骨盤臓器脱：疫学、危険因子、臨床症状、およびマネージメントの概要 pelvic organ prolapse in women an overview of the epidemiology risk factors clinical manifestations and management

English Journal

Transvaginal perineal body repair for low rectocele.

Petros P, Inoue H.SourceAcademic Department of Surgery, St Vincent's Hospital Clinical School, University of New South Wales, Sydney, Australia, pp@kvinno.com.
Techniques in coloproctology.Tech Coloproctol.2013 Feb 16. [Epub ahead of print]
We describe our technique of low rectocele repair which is based on the approximation and lifting of the laterally displaced perineal bodies (PBs) using the Tissue Fixation System©, a 7-mm-wide tensioned macropore polypropylene sling. In low rectocele, the PB between the rectum and vagina is thinne
PMID 23417773

Laparoscopic ventral rectopexy for rectal prolapse and symptomatic rectocele: an analysis of 245 consecutive patients.

Formijne Jonkers HA, Poierrié N, Draaisma WA, Broeders IA, Consten EC.SourceMeander Medical Centre, Department of Surgery, Amersfoort, the Netherlands.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.Colorectal Dis.2013 Feb 13. doi: 10.1111/codi.12113. [Epub ahead of print]
AIM: This retrospective study aimed to determine functional results of Laparoscopic Ventral Rectopexy (LVR) for rectal prolapse (RP) and symptomatic rectoceles in a large cohort of patients.METHODS: All patients treated between 2004 and 2011 were identified. Relevant patient characteristics were gat
PMID 23406289

Pelvic floor imaging: comparison between magnetic resonance imaging and conventional defecography in studying outlet obstruction syndrome.

Foti PV, Farina R, Riva G, Coronella M, Fisichella E, Palmucci S, Racalbuto A, Politi G, Ettorre GC.SourceIstituto di Radiologia, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", P.O. "Gaspare Rodolico" di Catania, Via Santa Sofia 78, 95123, Catania, Italy, pietrofoti@hotmail.com.
La Radiologia medica.Radiol Med.2013 Feb;118(1):23-39. Epub 2012 Jun 28.
PURPOSE: This study prospectively compared the diagnostic capabilities of magnetic resonance (MR) imaging with conventional defecography (CD) in outlet obstruction syndrome.MATERIALS AND METHODS: Nineteen consecutive patients with clinical symptoms of outlet obstruction underwent pelvic MR examinati
PMID 22744345

Japanese Journal

4) 腟壁と膀胱・尿道間の微小交感神経束を温存する合成メッシュ骨盤底再建手術(シンポジウム1:女性ヘルスケア「中高年に対する女性医学の展開」,第64回日本産科婦人科学会・学術講演会)

古山将康
日本産科婦人科學會雜誌 64(10), 2203-2213, 2012-10-01
… Supporting abnormality of a pelvic floor develops pelvic organ prolapse (POP) such as uterine prolapse, cystocele, rectocele, lower urinary tract symptoms through childbirth and estrogen depletion. …
NAID 110009518076

Investigation of Patients with Rectal Prolapse

神山剛一,荒木靖三,野明俊裕,鍋山健太郎,岩谷泰江,小篠洋之,的野敬子,岩本一亜,新垣淳也,佐藤郷子,高野正博
日本大腸肛門病学会雑誌 65(10), 833-839, 2012
… Recent advances in the dynamic study of pelvic floor imaging have shown that rectal prolapse is accompanied with pelvic organ prolapse, such as cystocele, enterocele, and rectocele. …
NAID 130002548305

骨盤臓器脱（膀胱瘤，子宮脱，直腸瘤）に合併した直腸癌の1例

山川俊紀,鈴鹿伊智雄,久保孝文,大橋龍一郎,塩田邦彦
日本大腸肛門病学会雑誌 65(7), 388-392, 2012
骨盤臓器脱（膀胱瘤，子宮脱，直腸瘤）に合併した直腸癌の1例を経験したので報告する．症例は63歳の女性．2007年頃より子宮の脱出を認め，徒手還納していた．2009年9月末に突然尿閉となり，当院泌尿器科受診．精査にてGrade3の子宮脱に伴う膣前後壁の翻転による，外尿道口圧迫が尿閉の原因であった．膣後壁より腫瘤様に膨大する部位を認め精査目的で当科紹介．精査の結果，直腸瘤と直腸（RaRb）前壁に径40 …
NAID 130002123697

Related Pictures

★リンクテーブル★

リンク元	「直腸瘤」「直腸腟壁弛緩症」

「直腸瘤」

Rectocele
	Sagittal section of the lower part of a female trunk, right segment. (Rectovaginal fascia not labeled, but region is visible.)
Classification and external resources
Specialty	urology
ICD-10	N81.6
ICD-9-CM	618.04
DiseasesDB	11189
eMedicine	med/3325
MeSH	D020047

　　[★]

英: rectocele
関: 直腸腟壁弛緩症

「直腸腟壁弛緩症」

　　[★]

英: rectocele
関: 直腸瘤

[1] Chen, HH; Iroatulam, A; Alabaz, O; Weiss, EG; Nogueras, JJ; Wexner, SD (December 2001). "Associations of defecography and physiologic findings in male patients with rectocele.". Techniques in coloproctology 5 (3): 157–61. doi:10.1007/s101510100018. PMID 11875683.

[Coloproctology-2] Wexner, edited by Andrew P. Zbar, Steven D. (2010). Coloproctology. New York: Springer. ISBN 978-1-84882-755-4.

[titleRectocele:_Risk_factors_-_MayoClinic.com-3] "Rectocele: Risk factors - MayoClinic.com". Retrieved 2007-11-21.

[pmid17132479-4] Paraiso MF, Barber MD, Muir TW, Walters MD (2006). "Rectocele repair: a randomized trial of three surgical techniques including graft augmentation". Am. J. Obstet. Gynecol. 195 (6): 1762–71. doi:10.1016/j.ajog.2006.07.026. PMID 17132479.

[Speranza2012-5] Rectocele, by Jennifer Speranza, MD at American Society of Colorectal Surgeons. Reviewed 2012

[AUSFive-6] American Urogynecologic Society (May 5, 2015), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American Urogynecologic Society), retrieved June 1, 2015 , which cites:

Maher, C; Feiner, B; Baessler, K; Schmid, C (30 April 2013). "Surgical management of pelvic organ prolapse in women.". The Cochrane database of systematic reviews 4: CD004014. PMID 23633316.

Paraiso, MF; Barber, MD; Muir, TW; Walters, MD (December 2006). "Rectocele repair: a randomized trial of three surgical techniques including graft augmentation.". American journal of obstetrics and gynecology 195 (6): 1762–71. PMID 17132479.

Sung, VW; Rardin, CR; Raker, CA; Lasala, CA; Myers, DL (January 2012). "Porcine subintestinal submucosal graft augmentation for rectocele repair: a randomized controlled trial.". Obstetrics and gynecology 119 (1): 125–33. PMID 22183220.

[7] Maher, C; Feiner, B; Baessler, K; Schmid, C (30 April 2013). "Surgical management of pelvic organ prolapse in women.". The Cochrane database of systematic reviews 4: CD004014. PMID 23633316.

[8] Paraiso, MF; Barber, MD; Muir, TW; Walters, MD (December 2006). "Rectocele repair: a randomized trial of three surgical techniques including graft augmentation.". American journal of obstetrics and gynecology 195 (6): 1762–71. PMID 17132479.

[9] Sung, VW; Rardin, CR; Raker, CA; Lasala, CA; Myers, DL (January 2012). "Porcine subintestinal submucosal graft augmentation for rectocele repair: a randomized controlled trial.". Obstetrics and gynecology 119 (1): 125–33. PMID 22183220.

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rectocele