Pelvic Floor Disorders

Pelvic floor disorders, such as a rectal prolapse, rectocele or an enterocele, may cause discomfort during bowel movements and often cause a feeling of constipation.

The pelvic floor is composed of a large group of muscles that serve to support the organs above, and the rectum which passes through the pelvic floor.  Dysfunction of these pelvic floor muscles may lead to annoying symptoms.

Rectocele

A rectocele is a common dysfunction of the pelvic floor that occurs most often in women. A rectocele is diagnosed when the rectal lining has pushed forward into the wall of the vagina. This often occurs when the fascia, the thin wall that separates the rectum from the vagina, becomes weakened. A rectocele is often the result of severe pressure on the fascia, such as that which occurs during child birth.

Symptoms of a rectocele include:

  • A protruding bulge in the tissue of the vagina.
  • Difficulty during bowel movements
  • Rectal pressure
  • Consistent feeling of fullness

Treatment Methods For A Rectocele

A common form of treatment for a rectocele is with a vaginal pessary. This is a plastic or rubber ring that is placed within the vagina and acts as a support to the bulging tissues. The pessary often requires a high level of maintenance and many women chose to pursue other treatment methods, such as operative correction.  The surgical procedure varies based upon anatomic considerations and the experience of the surgeon.   In most situations, a vaginal or rectal approach effectively treats the rectocele.

Enterocele

Another common disorder of the pelvic floor is an enterocele, which is diagnosed when the small intestine drops low into the pelvis and presses against the rectum.  This is most common in women.  This gives the patient a feeling of the need to evacuate even though there is no stool in the rectum.  An enterocele is often found in women who have undergone a hysterectomy, or the surgical removal of the uterus.

Symptoms of an enterocele include:

  • A pulling sensation within the pelvis that is often only alleviated by lying down
  • Pain in the lower back
  • Vaginal discomfort and dyspareunia (pain during intercourse)
  • A feeling of the need to pass a bowel movement, without any results

Treatment Methods For An Enterocele

As an enterocele is the abnormal location of small intestine deep in the pelvic cavity, several operations exist to close that space and prevent the intestine from pressing against the rectum.  This will usually ameliorate the symptoms.

Rectal Prolapse

Rectal prolapse occurs when the circumferential full thickness of the rectal wall protrudes through the anal canal.  The condition is most commonly observed in older females, but may occur in either gender or at any age.

The cause of rectal prolapse centers on a lack of fixation of the rectum in the pelvis.  The rectum is normally stabilized within the pelvis by a group of pelvic muscles, ligaments on either side of the rectum and  fibro-fatty support.

Disruption of this support network may occur for a variety of reasons.  In younger patients with rectal prolapse, a congenital lack of rectal fixation may result in full-thickness rectal protrusion.  In the older female population, this lack of rectal fixation is usually secondary to the chronic ligamentous and muscular stretching of vaginal child-birth, or after a hysterectomy.  The risk may increase with the number of vaginal deliveries.

Treatment Methods For Rectal Prolapse

The repair of a rectal prolapse is surgical and is performed by either a perineal or an abdominal approach.

A prime benefit of the perineal approach is that it can performed using local anesthesia and intravenous sedation.  In the perineal approach, the protruding rectum is surgically removed so that no visible prolapse remains.  The perineal approach is reserved for those patients with concomitant medical problems (usually the elderly), and for those people unwilling to undergo an abdominal operation.

The abdominal approach is favored because of its lower recurrence rate.  The abdominal repair of the prolapse (rectopexy) involves the mobilization and subsequent  re-fixation of the rectum along the sacral promontory using suture or artificial material.  A laparoscopic approach may be used but should be performed by surgeons specifically trained in the technique.  Experience with the laparoscopic repair of rectal prolapse has shown to provide much less postoperative discomfort and has reduced the length of patient hospitalization.

For most women, disorders of the pelvic floor are uncomfortable but not particularly painful. Operative treatment is elective.  You should consult your physician to discuss your symptoms and possible treatments.