Repair of Rectocele or Enterocele

Repair of Rectocele or Enterocele

Surgery Overview

A
rectocele occurs when the end of the large intestine
(rectum) pushes against and moves the back wall of the
vagina. An enterocele (small bowel prolapse) occurs
when the small bowel presses against and moves the upper wall
of the vagina.
Rectoceles and
enteroceles develop if the lower pelvic muscles become
damaged by labor, childbirth, or a previous pelvic surgery or when the muscles
are weakened by aging. A rectocele or an enterocele can be present at birth
(congenital), though this is rare.

A rectocele or an enterocele
may become large or more obvious when you strain or bear down (for example,
during a bowel movement). A rectocele and an enterocele may occur
together.

Because rectocele and
enterocele are defects of the pelvic supporting tissue and not the bowel wall,
they are treated most successfully with surgery that repairs the vaginal wall.
This surgery pulls together the stretched or torn tissue in the area of
prolapse. Surgery will also strengthen the wall of the vagina to prevent
prolapse from recurring. Unless there is another health problem that would
require an abdominal incision, rectoceles and enteroceles are usually repaired
through the vagina.

What To Expect After Surgery

General anesthesia is usually used for repair of a rectocele or enterocele. You
may stay in the hospital from 1 to 2 days. Most women can return to their
normal activities in about 6 weeks. Avoid strenuous activity for the first 6
weeks. And increase your activity level gradually.

Normal bowel
function returns within 2 to 4 weeks. It is important to avoid constipation
during this time. Your doctor will give you special bowel care instructions. But it is important to include sources of
fiber and adequate fluids in your diet. Try
to drink about 6 to 8 glasses of water a day.

Most women are able
to resume sexual intercourse in about 6 weeks.

Why It Is Done

Surgical repair of rectoceles and
enteroceles is used to manage symptoms such as movement of the intestine that
pushes against the wall of the vagina, low back pain, and painful intercourse.
An enterocele may not cause symptoms until it is so large that it bulges into
the midpoint of the vaginal canal.

Rectocele and enterocele often
occur with other pelvic organ prolapse, so tell your doctor about other
symptoms you may be having. If your doctor finds a bladder prolapse (cystocele), urethral prolapse (urethrocele),
or
uterine prolapse during your pelvic exam, that
problem can also be repaired during surgery.

How Well It Works

Not much is known about how well the
surgery works over time. The surgery is more likely to be successful if the
woman can avoid constipation, does not go through pregnancy and delivery, and
does not have any other pelvic organ prolapse.footnote 1

Risks

Risks of rectocele and enterocele repair are
uncommon but include:

  • Urinary retention.
  • Bladder
    injury.
  • Bowel or rectal
    injury.
  • Infection.
  • Painful
    intercourse.
  • Formation of an abnormal connection or opening between
    two organs (fistula).

What To Think About

Pelvic organ prolapse is strongly
linked to labor and vaginal delivery. So you may want to delay surgical repair
of a rectocele or enterocele until you have finished having children.

Surgical repair may relieve some, but not all, of the problems caused by
a rectocele or enterocele.

  • If pelvic pain, low back pain, or pain with
    intercourse is present before surgery, the pain may still occur after
    surgery.
  • Symptoms of constipation may return following
    surgery.
  • The success rate is lower if you have had previous pelvic
    surgery or
    radiation therapy to the pelvis.

You can control many of the activities that contributed to
your rectocele or enterocele or made it worse. After surgery:

  • Avoid smoking.
  • Stay at a healthy
    weight for your height.
  • Avoid constipation.
  • Avoid
    activities that put strain on the lower pelvic muscles, such as heavy lifting
    or long periods of standing.

Complete the surgery information form (PDF) ( What is a PDF document? ) to help you prepare for this surgery.

References

Citations

  1. Tarnay CM (2007). Pelvic organ prolapse. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 720–734. New York: McGraw-Hill Medical.

Credits

ByHealthwise StaffPrimary Medical Reviewer Sarah Marshall, MD - Family Medicine Kathleen Romito, MD - Family Medicine Martin J. Gabica, MD - Family Medicine Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology

Current as ofDecember 7, 2017

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