Pelvic Floor Disorders

Abstract

A common clinical definition of rectocele is abnormal rectovaginal anatomy that allows the rectum to be in direct contact with the vaginal serosa without an intervening layer. Usually, rectoceles are diagnosed when rectovaginal support abnormalities are observed during physical examination. There may be protrusion of the posterior vaginal wall beyond the hymen with or without strain effort. The differential diagnosis for this physical finding includes other abnormalities of vaginal attachment, usually the vaginal apex (with or without the uterus). Differences in physical examination techniques affect the degree of prolapse that is detected. The side-lying or prone jackknife examination that is favored by many colon and rectal surgeons is sufficient to detect some forms of prolapse; however, the standing straining vaginal examination provides the best opportunity to determine the full extent of anatomic abnormalities. Another important differential diagnosis includes abnormalities in perineal support, including severe atrophy or denervation of the levator muscles. Some specialists use fluoroscopy as an aid to physical diagnosis. It is clear, however, that the finding of “rectocele” in asymptomatic women during fluoroscopic examination should not prompt surgical repair.