Treatment of Symptomatic High Rectocele Measuring at Least 3 cm with Straining
This protocol applies to patients with a symptomatic rectocele of 3 cm or more on straining — whether the finding is isolated or occurs alongside other pelvic floor disorders.
Clinical Scenario
Therapeutic management is indicated when a rectocele is symptomatic and measures at least 3 cm with straining. This includes both isolated high rectocele and cases associated with other pelvic floor disorders — such as enterocele, internal rectal prolapse, or involvement of the uterus or bladder.
Initial Management — Overview
A first-line trial of medical treatment focused on intestinal transit is the initial step in determining which patients require further intervention. Preoperative perineal muscular rehabilitation may also be relevant for patients with certain associated symptoms. The full management pathway and patient selection criteria are detailed in the complete protocol.
References
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.
- In the presence of a high rectocele, whether isolated or associated with other pelvic floor disorders such as enterocele, internal rectal prolapse, or involvement of the uterus or bladder, an abdominal approach with a laparoscopic ventral rectopexy is the preferred approach.
- 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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