Dietz H P, Steensma A B
Western Clinical School, Nepean Campus, University of Sydney, Penrith, Australia.
BJOG. 2006 Mar;113(3):264-7. doi: 10.1111/j.1471-0528.2006.00860.x.
Clinically, rectocele is common in parous women and assumed to be due to distension or tearing of the rectovaginal septum in labour. In a prospective study, we examined the prevalence of such defects in primiparae before and after childbearing in order to define the role of childbearing in the aetiology of rectocele.
Prospective observational study.
Tertiary urogynaecological clinic.
A total of 68 nulliparous women between 35 + 6 and 40 + 1 weeks of gestation.
Participants underwent a standardised interview and were assessed by translabial ultrasound. Presence and depth of a rectocele was determined on maximal Valsalva, as was descent of the rectal ampulla. Fifty-two women were reassessed 2-6 months postpartum.
Presence of a true rectocele, rectal descent.
True rectoceles were identified in 2 of the 68 women before childbirth and in 8 of the 52 women after childbirth (P = 0.02). After childbirth, the ampulla descended >22 mm further than before (P < 0.0001 on paired t test). Symptoms such as digitation (n = 2), straining at stool (n = 10) and incomplete emptying (n = 11) were not uncommon 2-6 months postpartum; but out of eight rectoceles, four were asymptomatic.
True rectoceles occur in young nulliparae. However, childbirth is associated with an increase in prevalence and size of such defects.
临床上，直肠膨出在经产妇中很常见，一般认为是分娩时直肠阴道隔扩张或撕裂所致。在一项前瞻性研究中，我们检查了初产妇在分娩前后此类缺陷的发生率，以明确分娩在直肠膨出病因学中的作用。
前瞻性观察研究。
三级泌尿妇科诊所。
总共68名妊娠35⁺⁶至40⁺¹周的未产妇。
参与者接受标准化访谈，并通过经阴唇超声进行评估。在最大瓦尔萨尔瓦动作时确定直肠膨出的存在及深度，同时确定直肠壶腹的下移情况。52名女性在产后2至6个月进行了重新评估。
真性直肠膨出的存在情况、直肠下移情况。
68名女性中，2名在分娩前被发现有真性直肠膨出，52名女性中，8名在产后被发现有真性直肠膨出（P = 0.02）。产后，直肠壶腹下移比产前多>22 mm（配对t检验，P < 0.0001）。产后2至6个月，手指插入感（n = 2）、排便用力（n = 10）和排空不全（n = 11）等症状并不少见；但在8例直肠膨出中，4例无症状。
年轻未产妇中存在真性直肠膨出。然而，分娩与此类缺陷的发生率增加及尺寸增大有关。
