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1
Definition
A proctocele refers to the condition when the rectum sags anteriorly and pushes against the vaginal wall. If there is a proctocele, it can be treated by managing defecation habits or simple surgery depending on its size.

Pelvic Anatomy

In the pelvis, the female genitalia is sandwiched between the urinary bladder, part of the urinary system, and the large intestine, part of the digestive system. The fascia and muscle, a thin layer of fibrous tissue, form a wall between the rear wall of the vagina and the rectum to prevent the rectum from being protruded. However, if the wall is weakened and cannot hold up, the rectum may not stay in position and push the vaginal wall.
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Causes
  • 1
    Proctoceles can be caused by the weakened muscles and fascia of the vaginal wall.
  • 2
    When a weak wall receives more pressure from lifting heavy objects or from excessive strain due to constipation, it will gradually stretch and form a large pocket.
  • 3
    The vagina is the path that the baby passes through to the birth canal. During childbirth, this wall is damaged and stretched due to excessive pressure, and when it weakens, a proctocele occurs.
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Types
  • 1

    1st degree

    The degree to which the vaginal wall is weakened and stretches slightly if you exert force during a bowel movement.
  • 2

    2nd degree

    The degree to which the stretched pocket may be pushed down to the entrance of the vagina if force is applied during a bowel movement.
  • 3

    3rd degree

    The degree to which the rectal pocket is pushed out of the vagina if force is applied during a bowel movement.
  • 4

    4th degree

    The degree to which the pocket remains prominently slided out from the vagina in resting state.
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Symptoms

  • 01

    Prolapse out of the vagina

  • 02

    Constipation

  • 03

    Frequent defecation

  • 04

    Sense of remaining feces after a bowel movement

  • 05

    Fecal incontinence
Diagnosis: Defecography
An artificial bowel movement is placed into the rectum to record the process of the stool coming down to determine the extent to which the rectum is pushed down during defecation, that is, the magnitude of the proctocele.
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Treatments
Symptomatic proctoceles require treatments. They can be treated by a surgical procedure that removes the pouch that is extending toward the vagina.

  • · Removing the stretched rectum through the anus

    If the intestinal wall is damaged, the patient's compliance is slightly reduced because of the long-term fasting that is required to prevent infection.

  • · Surgery performed inside the vagina

    It is convenient because there may cause no problem in a bowel movement after the operation.

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