Pelvic organ prolapse is a common and growing condition for which women seek help and frequently undergo surgical management. Prolapse of the posterior vaginal wall, alone or in combination with other compartment defects, can be a challenge for the pelvic surgeon. A clear understanding of the normal anatomy, interactions of the connective tissue and muscular supports of the pelvis, and the relationship or lack of relationship between anatomy and function is required. Vaginal support defects occur with and without symptoms, and many of the symptoms attributed to pelvic organ prolapse can result from other causes. Pelvic pressure, the need to splint the perineum to defecate, impaired sexual relations, difficult defecation, and fecal incontinence are some of the symptoms that have been correlated with rectoceles. Whether the prolapse is the cause of these symptoms or is a result of straining and stretching of support tissues in women with defecation disorders is still unknown. We will present the current literature on these relationships and what evaluations are useful when caring for a woman with a rectocele and defecation disorders. Either pessaries or surgery can be used for treating rectoceles. Several surgical techniques have been described, including transvaginal, transanal, abdominal, and the use of graft materials to treat both anatomical defects and functional symptoms. The success, rationale, and complications of each approach, including anatomic cure, impact on defecation, and sexual function, are presented.
To optimally treat rectoceles, symptoms must be thoroughly evaluated and treatment tailored to the patients’ symptoms.
From *Johns Hopkins Medicine, Baltimore, Maryland; and †University of Michigan, Ann Arbor, Michigan.
Address reprint requests to: Geoffrey Cundiff, MD, Johns Hopkins Medicine, Department of Obstetrics and Gynecology, 4940 Eastern Avenue, Room 125 A1C, Baltimore, MD 21224; e-mail: firstname.lastname@example.org.
Received May 24, 2004. Received in revised form September 13, 2004. Accepted September 16, 2004.