Rectocele

Introduction to rectocele The rectocele (RC) translation is rectal bulging, that is, the anterior rectal wall, also known as anterior rectal bulging. As one of the outlet obstructive syndromes, the patient's rectal vaginal septum and the rectal wall protrude into the vagina, which is also one of the main factors of difficulty in defecation. The disease is more common in middle-aged and elderly women, but in recent years there have been reports of male cases. basic knowledge The proportion of illness: 0.005%--0.007% Susceptible people: good for middle-aged women Mode of infection: non-infectious Complications: rectal intussusception

Rectal prolapse

Most scholars believe that the weak anterior wall of the rectum is the cause of rectocele. The anterior rectal wall is supported by the rectal vaginal septum. The septum is mainly composed of the pelvic fascia, which has the midline cross-fibrosis and perineal body of the levator ani muscle. If the rectal vaginal septum is loose, the anterior rectal wall tends to bulge forward, similar to sputum protrusion, more common in women with chronic constipation caused by long-term increase in intra-abdominal pressure, multi-partum women, poor bowel habits, and elderly women with perineal examination.

Childbirth, dysplasia, fascial degeneration and increased long-term abdominal pressure can damage the pelvic floor and relax, especially during childbirth, the interwoven fibers in the levator crease can be torn, and the abdominal fascia is stretched or torn. Splitting, thereby damaging the strength of the rectal vaginal septum, affecting its level of resistance to defecation and gradually protruding forward. This group of patients are more likely to have postpartum disease, suggesting that the disease is related to vaginal production; this disease occurs mostly in middle age. Tips may be related to the degeneration of connective tissue.

Rectal prolapse prevention

1. Develop good habits: including good eating habits and regular bowel habits, such as morning waking or after breakfast, use the stomach colon reflex to promote bowel movements.

2. Defecation time should not be too long: Generally, it should be 3~5min. Never read newspapers and books during defecation. If you don't concentrate, extend the time of defecation.

3. Avoid local damage: Women avoid birth injury during childbirth, and actively exercise appropriate physical exercise (mainly levator ani muscle exercise) after childbirth to promote recovery.

Rectal prolapse Complications

More combined with rectal anterior wall mucosal prolapse, rectal intussusception, perineal decline, intestinal fistula and so on.

Rectal prolapse symptoms Common symptoms Hematopoietic constipation and constipation

According to the above-mentioned typical medical history, symptoms and signs, the diagnosis of rectocele is not difficult. When a normal person uses force to excrete, the anterior upper part of the anorectal junction is sometimes bulged forward, and the length is longer, but the depth is generally not more than 5 cm. The domestic medical community has proposed rectal exudation angiography, which can be divided into three degrees: mild, with a protrusion depth of 0.6 to 1.5 cm, a moderate degree of 1.6 to 3 cm, and a severity of 3.1 cm.

In addition, Nichols et al suggested that the rectal prominence should be divided into three groups: low, median and high. The lower rectal prominence is caused by perineal tear during childbirth; the middle rectal protuberance is the most common, mostly caused by birth injury; the high rectum The anterior process is caused by 1/3 of the vagina, the main ligament, uterine fibular ligament destruction or pathological relaxation, often accompanied by vaginal posterior vaginal vagina, vaginal valgus, and uterine prolapse.

Difficulties in defecation are the main symptoms of rectocele. When the feces are forced to excrete, the abdominal pressure is increased. The feces are rushed forward under the pressure. After stopping the force, the feces are squeezed back into the rectum, causing difficulty in defecation due to feces. The block is stored in the rectum, and the patient feels falling. The bowel movement is not exhausted and the force is increased. As a result, the abdominal pressure is increased, so that the relaxed rectal vaginal fistula is subjected to greater pressure, thereby deepening the protrusion, thus forming a vicious circle and defecation. Difficulties are getting heavier, a small number of patients need to be in the perianal, vaginal pressure to help defecation, and even put your fingers into the rectum to excavate the feces, some patients have blood in the stool and pain in the anal canal.

Rectal prolapse examination

Digital rectal examination and defecal angiography are the main methods for the diagnosis of rectocele.

(1) refers to the examination: the rectal examination can touch the upper part of the rectum of the anal canal with a round or oval rounded weak area to the vagina, which is more prominent when forced to drain.

(2) Defecation angiography: It can be seen that the anterior wall of the rectum protrudes forward, and the sputum is difficult to pass through the anal canal. The shape of the anterior process is mostly bag-shaped, the horn is horn-like or mound-like, and the edge is smooth, such as the protrusion depth exceeding 2 cm. There are many tinctures embedded in the capsular bag; if combined with puborectal anterior muscle lesions, it is often marked with goose.

(3) Discharge test: insert a catheter connected to the balloon into the anus of the anus, inject 100ml of gas, let the patient force the defecation action, and understand the excretion function of the rectum. The normal person can discharge the balloon within 5 minutes, for more than 5 minutes. Delayed discharge, the author examined 39 cases, of which 2 cases were normal; 16 cases were discharged for >5 minutes, 8 cases were >7 minutes, 5 cases were >10 minutes, 6 cases were around 15 minutes, and 2 cases were still not discharged for 15 minutes. The positive rate was 94.9%.

Diagnosis of rectocele

diagnosis

Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.

Differential diagnosis

Mainly with constipation, rectal tumor, intestinal obstruction.

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