Advertisement

Diseases of the Colon & Rectum

, Volume 36, Issue 11, pp 1030–1036 | Cite as

Dyschezia and rectocele—A marriage of convenience?

Physiologic evaluation of the rectocele in a group of 52 women complaining of difficulty in evacuation
  • Laurent Siproudhis
  • Sylvie Dautrème
  • Alain Ropert
  • Jean -François Bretagne
  • Denis Heresbach
  • Jean -Luc Raoul
  • Michel Gosselin
Original Contributions

Abstract

Herniation of the anterior rectal wall into the lumen of the vagina (so called rectocele) may be encountered in patients who complain of constipation and emptying difficulties but it is difficult to ascertain whether this anatomic abnormality is an etiologic factor or a consequence of the dyschezia. PURPOSE: The aim of our study was to assess symptomatic, anatomic, and physiologic features encountered in women with a clearly defined rectocele in order to determine the predisposing factors, symptoms, functional associations, and effects on quantified rectal emptying. METHODS: Clinical, physiologic (manometry), and anatomic (evacuation proctography) assessments were carried out in 26 consecutive women (mean age, 47.6±12 years) with dyschezia and a large rectocele as evidenced by radiography and compared with a group of 26 consecutive women complaining of dyschezia without a significant rectocele (mean age, 42.6±14 years). Both groups were similar with respect to mean age, parity, laxative abuse, manual anal evacuation, fecal incontinence, urgency, and weekly stool frequency. RESULTS: Patients having a rectocele differed significantly from those without a rectocele in having frequent endovaginal digitation during defecation (7 vs. 1,P < 0.05), more frequent symptoms of urinary incontinence (14 vs. 3,P <0.001), and a surgical history of hysterectomy (9 vs. 2,P < 0.05). The rectocele group differed in having a delayed rectal emptying (55.5±38 vs. 30.3±23 seconds,P <0.005), a more frequent incomplete rectal emptying (23 vs. 11,P <0.0005), and was more often associated with a manometric anismus (16 vs. 6,P <0.01). During the straining effort, there was a correlation between the depth of the rectocele and the duration of rectal emptying (rs=0.3,P <0.05). In the group without manometric anismus, women with a rectocele (n=10) had a more incomplete rectal emptying than those without rectocele (8/10 vs. 8/19,P =0.05). CONCLUSION: Some of our results indicate that the rectocele itself could be a contributory factor in difficult evacuation. These results also exhibit the importance of other disorders, such as anismus, in the occurrence of dyschezia. Physiologic examination therefore should be made before considering surgical repair in any patient with rectocele and dyschezia.

Key words

Anus Rectum Rectocele Anismus Constipation Defecography 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Arnold MW, Stewart WR, Aguilar PS. Rectocele repair: four years' experience. Dis Colon Rectum 1990;33:684–7.PubMedGoogle Scholar
  2. 2.
    Siproudhis L, Ropert A, Lucas J,et al. Defecatory disorders, anorectal and pelvic floor dysfunction: a polygamy? Int J Colorectal Dis 1992;7:102–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Block IR. Transrectal repair of rectocele using obliterative suture. Dis Colon Rectum 1986;29:707–11.PubMedGoogle Scholar
  4. 4.
    Johansson C, Nilsson BY, Holmström B, Dolk A, Mellgren A. Association between rectocele and paradoxical sphincter response. Dis Colon Rectum 1992;35:503–9.PubMedGoogle Scholar
  5. 5.
    Yoshioka K, Matsui Y, Yamada O,et al. Physiologic and anatomic assessment of patients with rectocele. Dis Colon Rectum 1991;34:704–8CrossRefPubMedGoogle Scholar
  6. 6.
    Wald A, Caruana BJ, Freimanis MG, Bauman DH, Hinds JP. Contributions of evacuation proctography and anorectal manometry to evaluation of adults with constipation and defecatory disorders. Dig Dis Sci 1990;35:4:81–7.CrossRefGoogle Scholar
  7. 7.
    Dederding JP, Fouillet P, Berclaz R,et al. Constipation et incontinence: interet du temps de transit colique, de la manometrie ano-rectale et de la defecographie. Schweiz Med Wochenschr 1991;121:150–5.PubMedGoogle Scholar
  8. 8.
    Turnbull GK, Bartram CI, Lennard-Jones JE. Radiologic studies of rectal evacuation in adults with idiopathic constipation. Dis Colon Rectum 1988;31:1:90–7.PubMedGoogle Scholar
  9. 9.
    Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW. Defecography in normal volunteers: results and implications. Gut 1989:30:1:737–49.Google Scholar
  10. 10.
    Siproudhis L, Ropert A, Vilotte J,et al. How accurate is clinical examination in diagnosing and quantifying pelvirectal disorders? Dis Colon Rectum 1993;36:430–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Bartram CI, Turnbull GK, Lennard-Jones JE. Evacuation proctography: an investigation of rectal expulsion in 20 subjects without defecatory disturbance. Gastrointest Radiol 1988;13:72–80.CrossRefPubMedGoogle Scholar
  12. 12.
    Finlay IG. Symposium proctography. Int J Colorectal Dis 1988;3:67–89.CrossRefPubMedGoogle Scholar
  13. 13.
    McCue JL, Thomson JP. Rectopexy for internal intussusception. Br J Surg 1990;77:632–4.PubMedGoogle Scholar
  14. 14.
    Sarles JC, Arnaud A, Selezneff I, Olivier S. Endorectal repair of rectocele. Int J Colorectal Dis 1989;4:167–71.CrossRefPubMedGoogle Scholar
  15. 15.
    Khubchandani IT, Sheets JA, Stasik JJ, Hakki AR. Endorectal repair of rectocele. Dis Colon Rectum 1983;26:792–6.PubMedGoogle Scholar
  16. 16.
    Sehapayak S. Transrectal repair of rectocele: an extended armamentarium of colorectal surgeons. A report of 355 cases. Dis Colon Rectum 1985;28:422–33.PubMedGoogle Scholar
  17. 17.
    Smith AN, Varma JS, Binnie NR, Papachrysostomou M. Disordered colorectal motility in intractable constipation following hysterectomy. Br J Surg 1990;77:1361–6.PubMedGoogle Scholar
  18. 18.
    Preston D, Lennard-Jones JE. Anismus in chronic constipation. Dig Dis Sci 1985;30:413–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Mathers SE, Kempster PA, Swash M, Lees AJ. Constipation and paradoxical puborectalis contraction in anismus and Parkinson's disease: a dystonic phenomenon? J Neurol Neurosurg Psychiatry 1988; 51:1503–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Mathers SE, Kempster PA, Law PJ,et al. Anal sphincter dysfunction in Parkinson's disease. Arch Neurol 1989;46:1061–4.PubMedGoogle Scholar
  21. 21.
    Wexner SD, Cheape JD, Jorge JM, Heymen S, Jagelman DG. Prospective assessment of biofeedback for the treatment of paradoxical puborectalis contraction. Dis Colon Rectum 1992;35:145–50.CrossRefPubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1993

Authors and Affiliations

  • Laurent Siproudhis
    • 1
  • Sylvie Dautrème
    • 1
  • Alain Ropert
    • 1
  • Jean -François Bretagne
    • 1
  • Denis Heresbach
    • 1
  • Jean -Luc Raoul
    • 1
  • Michel Gosselin
    • 1
  1. 1.Service d'Hépato-GastroentérologieCHU PontchaillouRennesFrance

Personalised recommendations