The silent problem
Rectocele develops when the rectovaginal septum is weakened - most often after childbirth, with chronic constipation and with age. The anterior wall of the rectum protrudes into the vagina, and feces are retained in the resulting pocket. A typical complaint that patients usually do not talk about themselves: in order to empty the intestines, you have to help yourself with your hand through the perineum or vagina. Also disturbing is the feeling of incomplete emptying and the need to strain. The operation restores the septum and strengthens it with its own tissue. When combined with prolapse of other pelvic organs, the scope of the intervention is expanded, so the examination includes an examination by a gynecologist.
Why does the fistula not heal on its own?
Pararectal fistula is a pathological channel between the lumen of the rectum and the skin of the perineum. Most often, it is formed as a result of acute paraproctitis: the abscess has opened, the pus has come out, but the tract lined with epithelium remains.
The walls of the fistula do not grow together, so antibiotics and ointments provide only a temporary lull - the process periodically worsens. The only radical treatment method is surgical.
Classification in relation to the sphincter
- intrasphincteric - inside the internal sphincter, the simplest
- transsphincteric - crosses part of the sphincter fibers
- extrasphincteric - bypasses the sphincter from the outside, the most complex
- incomplete internal - opens only into the intestinal lumen
- epithelial-coccygeal tract - a separate pathology of the sacrococcygeal region
Classic surgery or laser
With classic intervention, the fistula tract is excised with a scalpel along with scar tissue - the method is as radical as possible, but requires caution when the sphincter is involved. Laser destruction works differently: a thin light guide is introduced and processed from the inside, the walls coagulate and collapse. The sphincter muscle is not crossed, so the risk of loss of control is minimal, and healing is faster. The choice of method is determined by the type of fistula, the presence of leaks and previous operations.