Rectocele Repair

Rectocele is when the rectum moves from its normal anatomical position to push the vagina and bulge into it. It results from weakened musculature and supportive structures of the rectum common in diseases such as constipation or after normal childbirth.
Play Video

Rectocele Repair

Play Video

Rectocele is when the rectum moves from its normal anatomical position to push the vagina
and bulge into it. It results from weakened musculature and supportive structures of the
rectum common in diseases such as constipation or after normal childbirth.

Indications

The Rectocele can be quite discomforting to the patient because of the pressure it exerts on the vagina. The patient’s preference to alleviate the symptoms of discomfort is a reason why the repair should be done. the rectocele bulging onto the vagina causes shame during sex for most women with the condition.

Indications

The Rectocele can be quite discomforting to the patient because of the pressure it exerts on the vagina. The patient’s preference to alleviate the symptoms of discomfort is a reason why the repair should be done. the rectocele bulging onto the vagina causes shame during sex for most women with the condition.

Sometimes the abnormal position of the rectum interferes with the normal movement of fecal matter. This will end up causing constipation. The surgery is indicated if it has gotten to this extent.
Other times the angle of the Rectocele is such that it results in incontinence of the fecal matter. The surgery is also highly indicated at this point.

How is the procedure done

The doctor has to assess if the patient is fit for a Rectocele repair surgery Consent is taken after explaining to the patient what the procedure is all about and its associated risks and benefits in a way that the patient understands.
  • The doctor accesses the rectum through the posterior wall of the vagina in a surgery called the posterior colporrhaphy.
  • The posterior part of the vagina is opened up and the rectum is repaired by stitching it back to its original position. This also stimulates the formation of scar tissue which aids in the adhesion process of the rectum to its anatomical position. The vagina is stitched with absorbable sutures and packed. Other methods like the transperineal and transanal approach may be used to repair the Rectocele, but the transvaginal is the most widely accepted with minimal risks.
A laparoscopic approach may be used and the fixation of meshwork to reinforce the fixation could also be employed using this method.

Risks

Sexual dysfunction still stands as the greatest risk of this surgery. This could be as a result of damage to the pelvic autonomic nerves during the surgical procedure or damage to the nerves during the healing process.
Because the surgery involves the rectum and its associated structures, proximate organs might be damaged during the surgical repair of the Rectocele.
If the patient is not fit for surgery, issues with the anesthesia might compromise the well being of the patient

How you prepare for the surgery

You are required to show up to the health care facility about a day to the surgery. This will give the caregivers enough time to run the lab blood tests required and other tests that might be required before the surgery. This provides a good assessment of the current status of the patient.
The caregivers will still assess if you are fit for the surgery particularly to prevent the adverse effects of the anesthesia. For the general anesthesia, you are required to fast for 8-12 hours before the surgical procedure.
The patient is then given prophylactic antibiotics before the surgery is done to prevent any infections
An intravenous line is required to feed the required drugs into the body system of the patient. A water drip may or may not be employed.
Because of the nature of the surgery, the patient is required to have a temporary urinary catheter to deliver the formed urine from the urinary bladder to prevent the bladder from becoming overfull during the surgery.
The pubic area of the patient is shaved in preparation for the surgery.

Recovery after surgery

The patients can be discharged a day or two after the procedure is done. The patient is fully healed in two months.
The patient should be given anticoagulants and advised to take frequent walks to avert clot formation which could be lethal.
Taking of any pain medication as recommended by the doctor is important because the surgery is associated with some pain postoperatively.
Avoid sexual intercourse until the wound is fully healed.
Laxatives could be prescribed to avoid constipation thus the healing process is much more successful.
There will be a vaginal discharge after the surgery in which normal sanitary towels can effectively absorb it. Frequent changes of these towels should be done to avert infections.

The patient should prepare for assistance during the recovery period with the home/work chores to prevent straining post-surgery.

Outcomes after surgery

The surgery has very good outcomes postoperatively. The patient might experience some mild urinary retention which will resolve with time. The general surgeons might be more comfortable using the transanal route but don’t despair.