The role of childbirth in the aetiology of rectocele

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 Measure 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.