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Clinical Summary

A rectocele is the herniation of the rectum through the posterior vaginal wall. Most small rectoceles are asymptomatic, but symptoms of introital bulging, constipation, and incomplete rectal evacuation may occur. Physical examination may reveal bulging of the posterior vaginal wall through the introitus. A thin-walled protrusion of the rectovaginal septum into the lower part of the vagina is seen on internal vaginal examination.

Management and Disposition

ED management is symptomatic with hydration, laxatives, and stool softeners. Refer patients with large or symptomatic rectoceles to a gynecologist for possible surgical repair.

FIGURE 10.36

Rectocele. This is characterized by bulging of the posterior vaginal wall at the introitus. (Photo contributor: Matthew Backer, Jr., MD.)

Pearl

  1. Patients may complain of the need for manual reduction of the rectocele when defecating.

FIGURE 10.37

Rectocele. Worsening of the rectocele with Valsalva. (Photo contributor: Matthew Backer, Jr., MD.)

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