Patients presenting to Dr Allison with this problem require investigations which will include a colonoscopy to ensure there is no bowel cancer causing the symptoms, a defaecogram (where dye is placed in the rectum and an x-ray is taken) is arranged through the xray department at Greenslopes Private Hospital. This helps assessing the causes of the obstructed defaecation including a rectocele, an enterocele, rectal intussusception, motility issues and pelvic floor descent. Other tests such as a anorectal physiology (click here) may be helpful.
Before the operation to repair the rectocele, an enema is given to evacuate the rectum. The operation can be performed via an abdominal or perineal approach. Dr Allison feels the abdominal approach with a robotic ventral rectopexy and rectocele repair is superior with regard to outcome and recovery. With this operation, a 5mm port (tube) is inserted into the abdominal cavity. After this, 4 robot ports are inserted. With the use of the robot, the rectum and vagina are separated to the level of the pelvic floor muscles. A biodegradable mesh is placed and fixed with sutures on to rectum to control the rectocele. After the operation, there is a 1-2 day stay in hospital. The biodegradable mesh disappears after 3 months. It is NOT permanent. After this procedure, you will have a catheter in your bladder which will be removed either 1 or 2 days post procedure.
For the perineal approach, an incision is made between anus and vagina. The rectocele is defined by separating the rectum from the vagina and repaired using a biodegradable mesh. This mesh makes the repair strong and disappears after 3 months.
After the procedure, you will have a pack in your vagina, and a catheter in the bladder. They will both be removed on the second postoperative day. The wound is left slightly open to allow discharge to drain rather than create a collection which could potentially become infected.