BJOG : an international journal of obstetrics and gynaecology · 2006
The role of childbirth in the aetiology of rectocele.
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Dietz H P, Steensma A B
Аннотация
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.
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.