A rectocele is the result of a defect in the rectovaginal septum (a tough fibrous layer), which separates the vagina (anteriorly) from the rectum (posteriorly). This defect results in the protrusion of the rectum into the vagina and the resultant symptoms.
The primary indication for repair of a rectocele is obstructive defecation with objective evidence of faecal trapping demonstrated through a defecating proctogram. Other indications include a subjective sensation of “pressure” in the vagina and a feeling of incomplete evacuation post-defecation. This may progress to difficult or painful defecation or sexual intercourse, constipation, incontinence, vaginal bleeding, and even prolapse of the bulge through the opening of the vagina.
Various approaches are employed in the repair of a rectocele including posterior colporrhaphy, trans-anal and trans-perineally.
Trans-anal Rectocele Repair: the procedure is performed under genera anaesthesia. An incision is generally made just proximal to the dentate line, the redundant rectal mucosa is either removed or plicated and the rectal submucosa and mucosa are closed in separate layers.
Trans-perineal Rectocele Repair: this approach is also performed under general anaesthesia. The recto-vaginal septum is repaired through an incision in the perineum and a decision whether or not to use a prosthetic mesh is made.