Clinical pearl: Given the rectal wall prolapse that occurs after stool evacuation in Pouch of Douglas hernia, some patients will describe a rectal lump that bleeds after a bowel movement.
However, a Pouch of Douglas hernia will be missed if the patient is not examined during Valsalva or maximal strain.
In our opinion, this finding distinguishes Pouch of Douglas hernia from a vaginal vault prolapse caused by an enterocele.
Asymmetric rectal prolapse affecting the anterior aspect of the rectal wall is consistent with a Pouch of Douglas hernia.
Basing the diagnosis of Pouch of Douglas hernia on physical examination alone can be difficult.
Several imaging modalities can be used to diagnose such disorders of the pelvic floor as Pouch of Douglas hernia.
In our experience, dynamic pelvic MRI has a high accuracy rate for diagnosing Pouch of Douglas hernia.
The primary goal of treatment for Pouch of Douglas hernia should be relief of bothersome symptoms.
Surgical repair of Pouch of Douglas hernia requires obliteration of the deep cul-de-sac (to prevent the small bowel from filling this space) and simultaneous pelvic floor reconstruction of the vaginal apex and any other compartments that are prolapsing (if pelvic organ prolapse is present).
