The role of childbirth in the aetiology of rectocele

Abstract

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 measures: 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.