Monday, May 7, 2012

Ask Us Anything: I Have a Grade One Retocele. Can You Help?

"Since my rectocele repair, I have not been able to have a normal bowel movement. I have to take 3 to 4 laxatives a day and 3 to 4 stool softeners as well. A test showed that I still have a grade one retocele and cystocele. Can you help me?"

Note: A rectocele occurs when the wall of tissue separating the rectum and vagina weakens, and the front wall of the rectum bulges into the vagina. It can occur after childbirth or pelvic surgery. It is sometimes present at birth, but this is rare. After surgical repair, normal bowel function should return within 2 to 4 weeks.

Dr. Ali Ghomi Responds:

One of the potential adverse effects after rectocele repair includes defecatory dysfunction (difficulty with moving the bowels). If this condition was not present prior to the surgery, one could assume that it is secondary to the the repair performed.

It is conceivable that there is a recurrence of a small rectocele, as you alluded to, which might be trapped between surrounding repaired/reinforced segments of the posterior vaginal wall. This, in turn, would interfere with the mechanism that is responsible for a successful defecation.

Physical examination would provide more information as to the etiology of this condition. In addition, defecography (a test by which contrast dye is injected into the rectum and an x-ray is taken during defecation in order to assess the movement of the rectum and any possible entrapment of the stool in the rectocele) may be considered. This test is seldom needed, however it may be helpful if deemed necessary.

Dr. Samuel Saleeb adds:

I do not know what kind of rectocele repair you had. But, generally speaking, it might end up with some scar tissue, or you might need pelvic floor physical therapy, which I do in my office. Or you might have chronic constipation.

By all means, you need careful history-taking and evaluation and then can take it from there.

About Our Physicians

Dr. Ghomi

Dr. Ghomi is the Director of Minimally Invasive Gynecologic Surgery and Chair of The Robotic Surgical Committee at Sisters of Charity Hospital.

Dr. Ghomi sees patients at the M. Steven Piver, M.D. Center for Women’s Health & Wellness in Buffalo.

Dr. Saleeb

Dr. Saleeb is a urogynecologist, which is a gynecologist who specializes in the care of women with pelvic floor dysfunction. He practices at the Saleeb Uro-Gynecology Center in Williamsville. He also practices twice monthly at the Ken-Ton FamilyCare Center in Tonawanda (a full evaluation of the pelvic floor is not available at this location).

He provides evaluation and management of pelvic floor disorders and offers clinical exams, urodynamic testing, cystoscopy, pelvic floor physical therapy, and behavioral therapy. He also manages a program for the prevention of pelvic floor disorders in women. At his research center, Dr. Saleeb is currently involved in three different studies.

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