Evaluation and treatment of women with rectocele: Focus on associated defecatory and sexual dysfunction

被引:83
作者
Cundiff, GW
Fenner, D
机构
[1] John Hopkins Med, Dept Obstet & Gynecol, Baltimore, MD 21224 USA
[2] Univ Michigan, Ann Arbor, MI 48109 USA
关键词
D O I
10.1097/01.AOG.0000147598.50638.15
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Pelvic organ prolapse is a common and growing condition, for which women seek help and frequently undergo surgical management. Prolapse of the posterior vaginal wall, alone or in combination with other compartment defects, can be a challenge for the pelvic surgeon. A dear understanding of the normal anatomy, interactions of the connective tissue and muscular supports of the pelvis, and the relationship or lack of relationship between anatomy and function is required. Vaginal support defects occur with and without symptoms, and many of the symptoms attributed to pelvic organ prolapse can result from other causes. Pelvic pressure, the need to splint the perineum to defecate, impaired sexual relations, difficult defecation, and fecal incontinence are some of the symptoms that have been correlated with rectoceles. Whether the prolapse is the cause of these symptoms or is a result of straining and stretching of support tissues in women with defecation disorders is still unknown. We will present the current literature on these relationships and what evaluations are useful when caring for a woman with a rectocele and defecation disorders. Either pessaries or surgery can be used for treating rectoceles. Several surgical techniques have been described, including transvaginal, transanal, abdominal, and the use of graft materials to treat both anatomical defects and functional symptoms. The success, rationale, and complications of each approach, including anatomic cure, impact on defecation, and sexual function, are presented. (C) 2004 by The American College of Obstetricians and Gynecologists.
引用
收藏
页码:1403 / 1421
页数:19
相关论文
共 78 条
[1]  
ADAMS E, 2004, COCHRANE LIB
[2]  
Addison WA, 1996, J GYNECOL TECH, V2, P69
[3]   RECTOCELE REPAIR - 4 YEARS EXPERIENCE [J].
ARNOLD, MW ;
STEWART, WRC ;
AGUILAR, PS ;
KHUBCHANDANI, IT .
DISEASES OF THE COLON & RECTUM, 1990, 33 (08) :684-687
[4]   Anal continence after rectocele repair [J].
Ayabaca, SM ;
Zbar, AP ;
Pescatori, M .
DISEASES OF THE COLON & RECTUM, 2002, 45 (01) :63-69
[5]   Sexual function in women with urinary incontinence and pelvic organ prolapse [J].
Barber, MD ;
Visco, AG ;
Wyman, JF ;
Fantl, JA ;
Bump, RG .
OBSTETRICS AND GYNECOLOGY, 2002, 99 (02) :281-289
[6]  
BARTOLO DCC, 1983, GASTROENTEROLOGY, V85, P68
[7]   TRANS-RECTAL REPAIR OF RECTOCELE USING OBLITERATIVE SUTURE [J].
BLOCK, IR .
DISEASES OF THE COLON & RECTUM, 1986, 29 (11) :707-711
[8]  
BRINK CA, 1994, NURS RES, V43, P352
[9]   Uterosacral ligament: Description of anatomic relationships to optimize surgical safety [J].
Buller, JL ;
Thompson, JR ;
Cundiff, GW ;
Sullivan, LK ;
Ybarra, MAS ;
Bent, AE .
OBSTETRICS AND GYNECOLOGY, 2001, 97 (06) :873-879
[10]   The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction [J].
Bump, RC ;
Mattiasson, A ;
Bo, K ;
Brubaker, LP ;
DeLancey, JOL ;
Klarskov, P ;
Shull, BL ;
Smith, ARB .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1996, 175 (01) :10-17