RECTOCELE (rectocele; lat. rectum a rectum + Greek kele a tumor) — the disease caused by protrusion of a front wall of a rectum in a vagina.
R.'s prevalence, the given A. G. Dzneladze (1948), makes 2,6% of all diseases of female generative organs. The disease seldom meets at young age, but in mature, elderly and especially at senile age its frequency increases.
The river arises at discrepancy of front bunches of the muscles lifting an anus and weakening of fabrics of a rectovaginal partition.
In R.'s pathogeny omission and loss of female generative organs, repeated childbirth, injuries in labor (gaps, obstetric manipulations), an inborn relaxation of ligaments, maldevelopment of generative organs, persistent locks, the hard physical activity connected with increase in intra belly pressure, hron matter. inflammatory diseases of female generative organs. Under these conditions a back wall vaginas (see), closely adjacent to to a rectum (see), gains mobility, the rectovaginal partition becomes thinner. At increase in intra belly pressure there is protrusion of a front wall of a rectum in the thinned rectovaginal partition.
On expressiveness the wedge, pictures distinguish three degrees of a disease.
The I degree — at a manual research of a rectum is defined a small pocket of front its wall (fig., b). At the same time inspected do not show complaints.
The II degree — existence of the expressed pocket of a front wall of a rectum reaching the level of an entrance of the vagina (fig., c); in some cases this pocket can contain a small amount of fecal masses. Complaints to the complicated defecation, feeling of incomplete rectum emptying are characteristic.
The III degree — protrusion of a back wall of a vagina extends out of limits of a sexual crack (fig., d), arises at increase in intra belly pressure, and sometimes and at rest. The back wall of a vagina is exposed to a xerosis, and at continuous loss ulcerates. At a manual research of a rectum big protrusion of its front wall in a vagina out of limits of an outside sphincter of an anus is defined. Sometimes in this protrusion fecal stones are found. Evacuation a calla is complicated, the feeling of incomplete emptying, frequent desires to defecation, the long unsuccessful natuzhivaniye causing restretching of sphincters of an anus and easing of their sokratitelny ability that can be followed by the phenomena of insufficiency of a press of an anus is noted. At a rektoskopiya (see. Rektoromanoskopiya ) inflammatory changes of a mucous membrane of a rectum can be observed. This degree of R. is often combined with loss of a front wall of a vagina, omission and a prolapse of the uterus (see. Prolapse of the uterus, vaginas ), to a tsistotsela (see).
Diagnosis is based on complaints of patients, results of a research of a rectum and vagina (see. Gynecologic research , Rectal research ). The research needs to be conducted on ginekol. chair. At a natuzhivaniye protrusion of a back wall of a vagina comes to light. During the manual research the front wall of a rectum is easily displaced in a vagina through its back wall. Determine the size of protrusion of a front wall of a rectum, its relation to an outside sphincter of an anus, existence of fecal stones, a condition of a rectovaginal partition, an arrangement of the muscles lifting an anus. At vaginal examonation establish a condition of female generative organs, thickness of a rectovaginal partition.
The river should be differentiated with hernias of a rectovaginal partition, at to-rykh unlike R. its thickness increases due to stratification and implementation of abdominal organs in it from rectouterine deepening (a back duglasov of space).
Treatment at the beginning of a disease can be conservative and include regulation of bowel emptying, LFK, and also the actions directed to strengthening of a tone of muscles of a diaphragm of a basin. Carrying pessaries belongs to the palliative ways applied at more expressed R.'s degrees when an operative measure is contraindicated. At the expressed R. operational treatment is shown, a cut is the most radical. Operation can be performed as under local anesthesia, and under anesthetic. After preliminary sanitation of a vagina excise the site of its back wall. The form of the excised rag can be various — from triangular (by Hegar's method) to yakoreobrazny or in the form of a butterfly (by Ott's method). Take in a front wall of a rectum in lengthwise or transverse direction P-ob-raznymi seams or put a purse-string stitch. Performance of back colporrhaphies (see) it has to be combined with obligatory sewing up of the muscles lifting an anus. The last can be carried out with allocation and without allocation of muscular educations (see. Colpoperineoplasty ). The way with allocation of the muscles lifting the anus offered by L. S. Persianinov (1976) is most effective.
At omission or a prolapse of the uterus an operative measure is combined with one of the ways providing a metropexy.
The bed rest is appointed to 7 — 9 days. For the same term detain defecation, and then cause it purpose of purgatives and a cleansing enema. In the postoperative period it is necessary to continue sanitation of a vagina, bandagings make daily. Heavy exercise stresses exclude within 2 — 3 months after operation.
Forecast at timely operational treatment favorable. A recurrence of a disease does not exceed 1,5%.
Bibliography: Abramova A. X. To an etiology of ruptures of a crotch and vagina in labor, in book: Vopr. morfol., under the editorship of M. N. Haitov, etc., page 68, Tashkent, 1965; Aminev A. M. Guide to a proctology, t. 2, page 437, Kuibyshev, 1971; Braude I. L. Operational gynecology, page 388, M., 1952; D to A. G zne-ladza. Frank prolapse, page 19, Tbilisi, 1948; P e r with and An and N about in L. S. Operational gynecology, with, 116, 288, M., 1976.
Yu. V. Dultsev.