This protocol applies when a low or mid rectocele is symptomatic and measures at least 3 cm with straining, and the predominant complaint is gynecological — most notably the sensation of a vaginal ball (posterior colpocele) — rather than obstructed defecation syndrome (ODS).
Therapeutic management is indicated when a rectocele is symptomatic and reaches at least 3 cm with straining. For low or mid rectocele without involvement of other pelvic floor levels, an approach from below is recommended as first intention. When gynecological complaints predominate, a transperineal or transvaginal approach may be proposed; when intestinal (ODS) complaints predominate, a transanal approach is advised instead.
As a first step, a trial of medical treatment aimed at regularising intestinal transit is initiated to identify which patients may ultimately need a surgical intervention. Preoperative perineal muscular rehabilitation may additionally be considered for certain associated symptoms. The full structured protocol covers the complete decision pathway and further steps.
DOI: 10.1016/j.jviscsurg.2020.10.001