H P Dietz1, A B Steensma. 1. Western Clinical School, Nepean Campus, University of Sydney, Penrith, Australia. hpdietz@bigpond.com
Abstract
OBJECTIVE: Clinically, rectocele is common in parous women and assumed to be due to distension or tearing of the rectovaginal septum in labour. In a prospective study, we examined the prevalence of such defects in primiparae before and after childbearing in order to define the role of childbearing in the aetiology of rectocele. DESIGN: Prospective observational study. SETTING: Tertiary urogynaecological clinic. POPULATION: A total of 68 nulliparous women between 35 + 6 and 40 + 1 weeks of gestation. METHODS: Participants underwent a standardised interview and were assessed by translabial ultrasound. Presence and depth of a rectocele was determined on maximal Valsalva, as was descent of the rectal ampulla. Fifty-two women were reassessed 2-6 months postpartum. MAIN OUTCOME MEASURES: Presence of a true rectocele, rectal descent. RESULTS: True rectoceles were identified in 2 of the 68 women before childbirth and in 8 of the 52 women after childbirth (P = 0.02). After childbirth, the ampulla descended >22 mm further than before (P < 0.0001 on paired t test). Symptoms such as digitation (n = 2), straining at stool (n = 10) and incomplete emptying (n = 11) were not uncommon 2-6 months postpartum; but out of eight rectoceles, four were asymptomatic. CONCLUSIONS: True rectoceles occur in young nulliparae. However, childbirth is associated with an increase in prevalence and size of such defects.
OBJECTIVE: Clinically, rectocele is common in parous women and assumed to be due to distension or tearing of the rectovaginal septum in labour. In a prospective study, we examined the prevalence of such defects in primiparae before and after childbearing in order to define the role of childbearing in the aetiology of rectocele. DESIGN: Prospective observational study. SETTING: Tertiary urogynaecological clinic. POPULATION: A total of 68 nulliparous women between 35 + 6 and 40 + 1 weeks of gestation. METHODS:Participants underwent a standardised interview and were assessed by translabial ultrasound. Presence and depth of a rectocele was determined on maximal Valsalva, as was descent of the rectal ampulla. Fifty-two women were reassessed 2-6 months postpartum. MAIN OUTCOME MEASURES: Presence of a true rectocele, rectal descent. RESULTS: True rectoceles were identified in 2 of the 68 women before childbirth and in 8 of the 52 women after childbirth (P = 0.02). After childbirth, the ampulla descended >22 mm further than before (P < 0.0001 on paired t test). Symptoms such as digitation (n = 2), straining at stool (n = 10) and incomplete emptying (n = 11) were not uncommon 2-6 months postpartum; but out of eight rectoceles, four were asymptomatic. CONCLUSIONS: True rectoceles occur in young nulliparae. However, childbirth is associated with an increase in prevalence and size of such defects.
Authors: Isabelle Ma van Gruting; Aleksandra Stankiewicz; Ranee Thakar; Giulio A Santoro; Joanna IntHout; Abdul H Sultan Journal: Cochrane Database Syst Rev Date: 2021-09-23