Este protocolo aborda a los pacientes con un rectocele bajo o medio sintomático que mide al menos 3 cm con el esfuerzo, en quienes las quejas intestinales — concretamente el síndrome de defecación obstruida (SDO) — constituyen la preocupación predominante y no los síntomas ginecológicos.
El paso inicial consiste en un ensayo de tratamiento médico orientado a la regularización del tránsito intestinal, considerando paralelamente la rehabilitación muscular perineal para los síntomas asociados cuando sea pertinente.
DOI: 10.1016/j.jviscsurg.2020.10.001
Therapeutic management should be initiated in the presence of a symptomatic rectocele, and measuring at least 3 cm with straining.
For low or medium rectocele without involvement of the other levels, an approach from below may be recommended as first intention.
If intestinal complaints (ODS) predominate, a transanal approach is advised.
As a first step, a trial of medical treatment (regularization of intestinal transit, oral and/or transanal laxatives) must be initiated to select which patients need surgery.
Preoperative perineal muscular rehabilitation should also be offered for symptoms associated with rectocele, such as anal incontinence or anismus, in order to improve postoperative functional results.
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