What is a Rectocele?
A rectocele is a significant bulge of the lower rectum which may catch stool making elimination difficult. The most common type of rectocele is when the rectum bulges into the vagina which is extremely common following childbirth, especially in multiple deliveries. If the stool catches in this pocket so severely that a woman must push on her vagina in order to eliminate then repair may be indicated. More rarely there is a condition known as a lateral rectocele where the bulge is to the side catching stool and causing the patient to need to push around the rectum with her fingers in order to allow the stool to come out.
Surgery for Rectocele
The most common type of operation to repair a rectocele is called the transvaginal rectocele repair. With the woman under anesthesia with her legs up in stirrups an incision is made in the back wall of the vagina and the vaginal lining is peeled away. The bulge is then clearly identified and pushed back inside and held with dissolvable sutures. Then musculature on both sides of the pelvis which was pushed out to the side by the delivery of the baby is brought back to the midline and held in place with strong sutures that take a long time to dissolve thus recreating a muscular wall in between the rectum and the vagina making it possible for the rectum to bulge forward and forcing the stool to pass out the anus in a more normal fashion. Usually an overnight stay is required after this type of surgery and in patients who are postmenopausal estrogen creams will cause the vaginal mucosa to heal much more rapidly. The patients are asked not to do any heavy lifting or straining for at least three weeks after this surgery. There is a small chance of a rectocele recurring over time.
STARR Procedure (Stapled Transanal Rectal Resection).
With the STARR procedure a special retractor is placed in the rectum and a suture is placed in the mucosa that bulges into the rectocele. This is pulled back into a special stapling device which is fired and amputates the excess tissue from within the rectum creating a strong flat rectal wall which will not bulge into the vagina. For redundant tissue on the sides and posteriorly a second firing of the staple removes this excess mucosa and recreates a more normal funnel at the end of the rectum channeling the stool out of the anus more normally. Most patients stay overnight after this procedure and are asked not to do any heavy lifting or straining for three weeks. Generally the STARR procedure is much less painful than a transvaginal rectocele repair. As it has only been available for a few years the long term efficacy of the procedure is yet to be determined. It generally has a very low complication rate.