Prevalence of rectocele in young nulliparous women
Article first published online: 14 SEP 2005
Australian and New Zealand Journal of Obstetrics and Gynaecology
Volume 45, Issue 5, pages 391–394, October 2005
How to Cite
DIETZ, H. P. and CLARKE, B. (2005), Prevalence of rectocele in young nulliparous women. Australian and New Zealand Journal of Obstetrics and Gynaecology, 45: 391–394. doi: 10.1111/j.1479-828X.2005.00454.x
- Issue published online: 14 SEP 2005
- Article first published online: 14 SEP 2005
- Received 31 March 2005; accepted 17 May 2005.
- 3D ultrasound;
- pelvic floor trauma;
- vaginal delivery
Background: It is generally assumed that fascial defects in the rectovaginal septum are the result of childbirth. However, rectoceles do occur in women who have never delivered vaginally.
Aims: To determine the incidence of rectocele in a cohort of asymptomatic, young nulliparous women.
Methods: Observational cohort study on 178 nulliparous caucasian women (aged 18–24) recruited for a twin study of pelvic floor dysfunction. All women were interviewed and examined by translabial ultrasound, supine and after voiding. In 52 women, 3D imaging was obtained and 171 datasets were complete and available for analysis. Ultrasound findings were reviewed for rectovaginal septal integrity by an assessor blinded against interview and demographic data for rectovaginal septal integrity.
Results: A discontinuity of the anterior rectal wall with extrusion of rectal mucosa or contents (depth of ≥ 10 mm) was observed in 21/171 (12%). The depth of this herniation ranged from 10 to 25 mm and was filled with stool (n = 10) or rectal mucosa (n = 11). Defects were associated with a higher BMI (P = 0.049), with the complaint of constipation (P = 0.049) and non-significantly with straining at stool (P = 0.09). Descent of the ampulla to beyond the level of the symphysis pubis without fascial defect, that is, significant perineal relaxation, was observed in 23/171 (13%).
Conclusions: Twelve percent of 171 young nulligravid caucasian women showed a defect of the rectovaginal septum. Associations were observed with higher body mass index and a history of constipation. It is hypothesised that in some women defects of the rectovaginal septum and perineal hypermobility may be congenital in nature.