Due to loose connective tissues; is the prolapse of the large intestine loops. Rectocele is the protrusion of the large intestine nodes from the posterior wall of the vagina.
When viewed from the outside, it is seen as a pink node. Vaginal hernia, intestinal hernia are staged at 4 degrees. It refers to 1st degree mild hernia and becomes evident when straining or lifting heavy weights while standing. 4th degree vaginal hernia; Even in the lying position, the intestinal folds come out of the vagina completely.
What is Vaginal Rectocele (Vaginal Hernia, Intestinal Hernia)?
Rectocele in the vagina is the protrusion of intestinal folds from the vaginal mucosa, that is, the inner membrane. Intestinal folds are not directly visible, but can be palpated under the mucous membrane. Rectocele is often associated with vaginal enlargement.
What is Vaginal Small Intestine Herniation?
Rectocele, that is, herniation of the large intestine; In non-operated patients, it may be slightly involved in the hernia sac in the small intestines. In this case, ileus due to intestinal obstruction and the need for emergency medical treatment may arise. Almost all vaginal hernias, including the small intestine, may require absolute treatment and surgery. If hernias, including the small intestine, are not treated, it may result in death.
Who Gets Vaginal Hernia, Intestinal Hernia?
Vaginal connective and muscle tissue can be obtained from the vaginal opening of all intra-abdominal organs. It has a structure that prevents it from coming out. However, tears in the connective and muscle tissue, especially with normal vaginal delivery, cause rectocele. In other words, although the birth is not through the normal vaginal way, having experienced pain and carrying the baby in the womb may be sufficient for a vaginal hernia or rectocele. Also:
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In obese women,
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With chronic cough,
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In smokers,
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Heavy lifters,
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People with connective tissue disease,
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Rectocele (vaginal hernia, intestinal hernia) is common ir.
Especially post-reproductive mothers are more likely to lift heavy loads during childcare. The rate of rectocele increases after normal vaginal delivery or cesarean delivery. and creates defects in muscle tissues. This defect is more prominent, especially in patients who do not exercise before giving birth.
If there is an anatomical tear, rectocele will progress over the years with coughing and heavy lifting, and it will cause stage 4, that is, a palpable mass even in the lying position. The perineal body between the anus and the vagina is the apex of the union of all vaginal and pelvic muscles and functions as a roof.
Perineal bady, that is, between the anus and the vagina opening, in the pelvic floor, there is a collapse and shortening due to birth in a 2-3 glass structure. rectocele becomes more prominent. If there is perineal body collapse, rectocele recurrence is inevitable if the muscle and connective tissues of this region are not repaired with perneoplasty (perianal area improvement) during rectocele surgery.
What are the Symptoms of Rectocele (Hernia in the Vagina)?
Although there is no complaint of a palpable mass, they may have various complaints.
The mass that is palpable in the vaginal region may not be in the resting position in stage 1 rectocele patients. However, there may be bowel folds that come out during straining, lifting heavy loads, and sexual intercourse. In stage 2 and above, protruding intestinal folds are mentioned, including the listening position. Apart from the herniated palpable mass from the vagina, patients with rectocele have the following complaints.
As a result of intestinal herniation, the angle for the stool reflex is impaired. Most patients cannot perform defecation without pushing the bowel from the vagina with their hand. Complaints that impair quality of life such as constipation, flatulence, and inability to defecate can be very common.
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Hemorrhoids due to constipation.
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Genital and pelvic The pain that starts after the morning in the region and increases with standing or movement towards the evening is the downward winding of the organs from this pelvis, the pulling pain of the intra-abdominal ligaments.
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Inability to get sexual pleasure due to vaginal width.
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Incontinence during sexual intercourse.
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Continuous vaginal discharge and odor.
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Pain during sexual intercourse, dyspareunia.
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A sound of gas leakage from the vagina when moving.
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Pain in the lower vaginal area.
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Complaints such as are seen in most patients.
Vaginal Hernia During Pregnancy
Vaginal hernia in pregnant women is usually seen in the 2nd or 3rd pregnancy. The presence of a traumatized vaginal structure in the first pregnancy is required. Especially after the 24th week, complaints of rectocele and hemorrhoids increase. It does not have any adverse effects on pregnancy or the fetus.
Can Pregnant Women with Rectocele Have Normal Delivery?
The presence of rectocele is not an obstacle for normal delivery. However, in the presence of excessively herniated (stages 3 and 4) vaginal hernias, it may disrupt the feeding of intestinal hernia while the baby is in the birth canal.
Insufficient blood flow in the intestines may cause intestinal ruptures and severe infections. For this reason, pregnant women in this situation should be examined by a gynecologist before birth planning. Another preference is to plan the delivery by cesarean section.
How to Treat Rectocele (Vaginal Hernia, Intestinal Hernia)?
Intestinal hernia, rectocele are within the same definition. If there is a mild rectocele with a slight vaginal enlargement and the patient does not want to have surgery, treatment with vaginal laser application can be tried.
How is Vaginal Rectocele Surgery Performed?
One of the important points in rectocele surgery Removal of only the vaginal mucosal tissue is not sufficient for rectocele repair, but also the vaginal muscle tissue and perineal body (the area between the anus and the vagina) should be repaired. In rectocele surgery, the herniated bowel sac is removed from the vaginal area, and the opening is closed with absorbable sutures. The operation time takes about 1 hour. General anesthesia or spinal anesthesia can be applied.
Vaginal Re After the rectocele Surgery
There may be mild pain on the first day after rectocele surgery, which can be relieved by painkillers. Especially, these patients state that they experience less pain than after delivery because they had normal delivery. You can take a standing shower the day after the surgery and the hospital stay is usually 1 day.
It is possible to return to work and normal life on the 3rd day. Activities such as heavy sports and heavy lifting should not be done for the first 10 days. As of the 4th week, there is no harm in having sexual intercourse.
Tight and hard clothes should not be preferred for the first 10 days, as it will cause pressure on the seams and cause discomfort after the surgery. In addition, since it will be important not to be constipated in terms of pain and straining, if you have hard stools, it is useful to request bowel softening medication support from your doctor.
How Long Does It Take to Have a Rectocele Surgery?
Rectocele surgery Return to normal life can begin on the 3rd day after However, the tissue heals completely and sexual activity begins around the 4th week. Surgically removed sutures are dissolvable sutures. Since the dissolvable sutures will strengthen the connective tissue, not removing them after surgery will keep the vaginal roof strong. sexual life is adversely affected.
Problems such as not being able to orgasm, sexual stimulation disorder, inability to feel the penis due to vaginal width affect both the patient and the partner negatively. In addition, the prolapse of the vaginal structure creates a manual correction during and before intercourse or a mass effect seen outside during intercourse. .
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