Rectocele and Uterine-Rectal Pouch: Symptoms and Diagnosis

Rectouterine pouch

Hello, Doctor: I previously underwent surgery for uterine prolapse, and since the operation, I have been experiencing difficulty with bowel movements.
Even when I do manage to pass stool, it is only a small amount, and I feel like I am not fully emptying my bowels.
Recently, I researched online and found some common causes of constipation in women, and I suspect I might be experiencing one of these symptoms.

1.
Rectocele: One of the main causes of constipation in women is rectocele, which is primarily due to childbirth or trauma that damages the rectovaginal septum, resulting in the anterior wall of the rectum bulging into the vagina.
During bowel movements, stool can fall into this pouch, causing it to accumulate toward the vagina and preventing complete evacuation.
2.
Uterine-Rectal Pouch with Internal Herniation: Normally, the peritoneum in a woman's pelvis folds from the bladder to the uterus and then to the anterior wall of the rectum, forming a uterine-rectal pouch.
If the surrounding tissues of the rectum become lax, this pouch can deepen, leading to the formation of a hernia sac.
During bowel movements, the sigmoid colon can herniate into this pouch, compressing the rectum and causing a series of obstructive symptoms.
The above two points were taken from the internet, and I feel that some terms may have been directly translated from Mainland Chinese to Taiwanese.
I would like to ask the doctor:
1.
Is rectocele the same as rectal prolapse?
2.
If rectal prolapse is indeed rectocele, what examinations can be performed to diagnose it? For example, colonoscopy, digital rectal examination, abdominal ultrasound, transvaginal ultrasound, X-ray, CT scan, or MRI?
3.
How can we determine if there is a hernia in the uterine-rectal pouch? What examinations would be necessary? For example, colonoscopy, digital rectal examination, abdominal ultrasound, transvaginal ultrasound, X-ray, CT scan, or MRI?
I look forward to your answers, thank you!

joan, 40~49 year old female. Ask Date: 2018/04/01

Dr. Ke Fangxu reply Surgery

Both of these conditions refer to rectocele, which can be diagnosed using a barium enema or defecography, as it is a dynamic issue that becomes more apparent during straining.
However, constipation is actually a very complex problem.
In addition to rectocele, there may be pelvic floor dysfunction or surgical alterations causing abnormal rectal angles, which can lead to difficulties in defecation even with soft stools.
To determine the exact cause of the defecation difficulties, further examination is necessary.

Reply Date: 2018/04/01

More Info

Understanding rectocele and uterine-rectal pouch issues is crucial for women experiencing symptoms related to pelvic floor dysfunction. Rectocele, a condition where the rectum bulges into the posterior wall of the vagina, can lead to significant discomfort and difficulties with bowel movements. This condition is often associated with childbirth and can result in a range of symptoms, including constipation, a sensation of incomplete evacuation, and pelvic pressure.

1. Is rectocele the same as rectal prolapse?
Rectocele and rectal prolapse are related but distinct conditions. Rectocele refers specifically to the bulging of the rectum into the vaginal wall, while rectal prolapse involves the rectum protruding through the anus. Both conditions can lead to similar symptoms, such as difficulty with bowel movements, but they are diagnosed and treated differently.

2. What tests can diagnose rectocele?
To diagnose rectocele, several diagnostic tools can be employed:
- Pelvic Examination: A thorough pelvic exam by a healthcare provider can often reveal signs of rectocele.

- Defecography: This specialized X-ray study evaluates how well the rectum and pelvic floor function during bowel movements.

- MRI or CT Scans: These imaging techniques can provide detailed images of the pelvic structures, helping to identify any abnormalities.

- Endoscopy: While a colonoscopy primarily examines the colon, it can sometimes provide insights into rectal issues.

- Ultrasound: Transvaginal ultrasound can be useful in assessing pelvic organ prolapse, including rectocele.

3. How to diagnose uterine-rectal pouch issues?
The uterine-rectal pouch, also known as the rectouterine pouch or pouch of Douglas, can also be evaluated through various methods:
- Pelvic Ultrasound: This non-invasive test can help visualize the pelvic organs and any abnormalities in the pouch.

- MRI: Magnetic resonance imaging is particularly useful for assessing soft tissue structures and can provide detailed images of the pelvic floor.

- Laparoscopy: In some cases, a minimally invasive surgical procedure may be necessary to directly visualize and assess the condition of the pelvic organs.

- Defecography: Similar to its use in diagnosing rectocele, this test can help evaluate how the rectum and surrounding structures function during bowel movements.

4. Symptoms and Management
Women with rectocele or issues related to the uterine-rectal pouch may experience symptoms such as:
- Difficulty with bowel movements or constipation
- A sensation of pressure or fullness in the pelvic area
- Pain during intercourse
- Urinary issues, such as urgency or incontinence
Management options vary based on the severity of the symptoms and the specific diagnosis. Conservative treatments may include pelvic floor exercises (Kegel exercises), dietary modifications to improve bowel habits, and the use of vaginal pessaries to support pelvic organs. In more severe cases, surgical intervention may be necessary to repair the rectocele or address any associated pelvic organ prolapse.

In conclusion, if you suspect you have rectocele or issues related to the uterine-rectal pouch, it is essential to consult with a healthcare provider who specializes in pelvic floor disorders. They can guide you through the appropriate diagnostic tests and develop a tailored treatment plan to address your symptoms effectively. Always remember that early diagnosis and intervention can significantly improve your quality of life.

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