This protocol addresses patients with a symptomatic low or mid rectocele measuring at least 3 cm with straining, in whom intestinal complaints — specifically obstructed defecation syndrome (ODS) — are the predominant concern rather than gynecological symptoms.
The initial step involves a trial of medical treatment targeting regularization of intestinal transit, with perineal muscular rehabilitation considered alongside for associated symptoms where relevant.
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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