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Rectocele in pregnancy, childbirth and puerperium — Clinical Guidelines

Overview

Rectocele, or posterior vaginal prolapse, can occur or be exacerbated during pregnancy, childbirth, and the puerperium due to increased intra-abdominal pressure and pelvic floor strain. 1 2

Diagnosis

Clinical assessment through pelvic examination, often requiring speculum or perineal inspection.

No specific diagnostic tests universally recommended; imaging may be considered in complex cases.

Grading systems (e.g., POP-Q) can quantify severity but are not extensively detailed in provided abstracts. 1 3

Management

Pelvic floor exercises and lifestyle modifications (e.g., weight management, avoidance of heavy lifting).

Use of pessaries for symptom relief and support in mild to moderate cases.

Surgical intervention considered for severe cases unresponsive to conservative management.

Specific drug classes or doses not detailed in provided abstracts. 1 3

Special Populations

Pregnancy and Childbirth: Increased risk due to hormonal changes and mechanical stress; multidisciplinary care involving midwives and obstetricians is crucial for effective patient outcomes. 1 6

Comorbidities: No specific details provided regarding management adjustments for comorbidities in the context of rectocele during pregnancy and postpartum. 1 2

Key Recommendations

Promote interprofessional collaboration between midwives and obstetricians to enhance patient care and address power differentials impacting care quality. (Evidence: Moderate) 1

Implement structured educational programs for medical students and residents involving midwives to improve understanding and management of pelvic floor disorders like rectocele. (Evidence: Expert opinion) 6

Utilize evidence-based guidelines such as Effective Care in Pregnancy and Childbirth to inform clinical practices, focusing on key findings rather than comprehensive overhauls initially. (Evidence: Moderate) 8 9

References

1 El Hussein MT, Jacoby S, Mclarnon M, Favell D, Dosani A. A concurrent mixed-method study exploring the experiences of interprofessional collaboration among Canadian midwives and obstetricians. Journal of advanced nursing 2024. link 2 Christianson M, Lehn S, Velandia M. The advancement of a gender ethics protocol to uncover gender ethical dilemmas in midwifery: a preliminary theory model. Reproductive health 2022. link 3 Exley J, Gupta PA, Schellenberg J, Strong KL, Requejo JH, Moller AB et al.. A rapid systematic review and evidence synthesis of effective coverage measures and cascades for childbirth, newborn and child health in low- and middle-income countries. Journal of global health 2022. link 4 Bovbjerg ML. Current Resources for Evidence-Based Practice, May 2019. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN 2019. link 5 Vannucci L, Frigenti L, Faussone-Pellegrini MS. From conception to birth: ancient library sources of embryology and women anatomy kept in the Biblioteca Biomedica of the Università degli Studi di Firenze (Biomedical Library of Florence University). Italian journal of anatomy and embryology = Archivio italiano di anatomia ed embriologia 2011. link 6 McConaughey E, Howard E. Midwives as educators of medical students and residents: results of a national survey. Journal of midwifery & women's health 2009. link 7 Paterson-Brown S, Fisk NM, Wyatt JC. Uptake of meta-analytical overviews of effective care in English obstetric units. British journal of obstetrics and gynaecology 1995. link 8 Stocking B. Implementing the findings of Effective Care in Pregnancy and Childbirth in the United Kingdom. The Milbank quarterly 1993. link 9 Sisk JE. Improving the use of research-based evidence in policy making: effective care in pregnancy and childbirth in the United States. The Milbank quarterly 1993. link

Rectocele in pregnancy, childbirth and puerperium