Treatment of Symptomatic Low or Mid Rectocele (≥ 3 cm) Predominantly Presenting with Obstructed Defecation

Clinical Scenario

This protocol applies to 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 presentation. Gynecological symptoms such as a vaginal ball sensation do not predominate in this setting.

Key Considerations

Therapeutic management is indicated for symptomatic rectoceles measuring at least 3 cm with straining. For low or mid rectocele without involvement of other pelvic levels, an approach from below is recommended as first intention. When obstructed defecation is the primary complaint, the surgical access route and technique selection are guided by the intestinal symptom profile.

Approach

When intestinal complaints predominate, a transanal surgical approach is recommended. Procedures within this approach can provide good symptom relief and may simultaneously address any associated internal rectal prolapse. An alternative technique with a chance of improving rectal emptying is also available — the complete structured regimen specifies which procedure applies and under what conditions.

Instant Access to Structured Evidence-Based Regimens

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.
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.
In this case, the STARR or TRANSTAR interventions can also treat an associated internal rectal prolapse and provide good relief to the patient.
The Sullivan technique is a possible alternative with a real chance of improving rectal emptying.

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