Este protocolo aborda pacientes com retocele baixa ou média sintomática medindo pelo menos 3 cm ao esforço, em que as queixas intestinais — especificamente a síndrome de defecação obstruída (SDO) — são a principal preocupação, e não os sintomas ginecológicos.
O passo inicial envolve um ensaio de tratamento médico visando a regularização do trânsito intestinal, com reabilitação muscular perineal considerada simultaneamente para sintomas associados quando relevante.
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.
View source ↗