Management of Rectocele with and without Obstructed Defecation

Rectoceles are a common finding in female patients; they can be asymptomatic, or they can contribute to the sensation of pelvic pain, pressure, and difficulty with evacuation. Rectoceles coexist with anterior and mid compartment pelvic prolapse in up to 50% of patients. Defecatory dysfunction can be secondary to anismus, anatomic abnormalities such as rectocele or intussusception, and often are due to a complex interplay of both structural and functional abnormalities. Hence patients presenting with these symptoms are best evaluated with anorectal physiology testing and dynamic imaging. Nonoperative approaches include pelvic floor physical therapy, biofeedback therapy, and vaginal pessaries. Various operative approaches exist, each with different targets and measurements of successful repair.