Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008 May;21(2):129-37.
doi: 10.1055/s-2008-1075862.

Functional disorders: rectocele

Roger Lefevre  1 , G Willy Davila
Affiliations

Functional disorders: rectocele

Roger Lefevre et al. Clin Colon Rectal Surg. 2008 May.

Abstract

The baseline prevalence of rectocele is not well defined as many women are asymptomatic and do not seek medical help. Gynecologists tend to perform posterior wall repairs more commonly than colorectal surgeons because they also address patients with vaginal symptoms in addition to those with defecatory dysfunction. Overall, surgical correction success rates for rectocele correction are quite high when using a vaginal approach. Vaginal dissection, as opposed to transrectal or transperineal approaches, results in better visualization and access to the endopelvic fascia and levator musculature, allowing for more firm anatomic correction. In addition, the maintenance of rectal mucosal integrity may reduce the risk of postoperative complications such as infection and fistula formation. With the rapidly growing popularity of synthetic and biologic implant kits in the field of pelvic reconstruction, outcomes data reporting is increasing and allowing surgeons to better understand the effect of various surgical techniques on vaginal, sexual, and defecatory symptoms.

Keywords: Rectocele; defecation disorders; dyspareunia; posterior colporrhaphy; site-specific defect rectocele repair.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Schematic representation of the rectovaginal septum including its attachment to the vaginal apex superiorly and perineal body inferiorly. (Reprinted with permission of Cleveland Clinic Florida, Weston, FL. Copyright © 2002.)
Figure 2
Figure 2
Lateral view of pelvis. Rectoceles typically develop between the levator plate and the perineal body due to weakness of the rectovaginal septum endopelvic fascia. (Reprinted with permission of Cleveland Clinic Florida, Weston, FL. Copyright © 2002.)
Figure 3
Figure 3
Fascial tears of the rectovaginal septum can occur superiorly or inferiorly at sites of attachment to a central tendon. (Reprinted with permission of Cleveland Clinic Florida, Weston, FL. Copyright © 2002.)
Figure 4
Figure 4
Surgical dissection is carried to the lateral vaginal sulcus to identify the fascia, which will be plicated for correction of posterior vaginal wall weakness.
Figure 5
Figure 5
Multiple interrupted sutures are used to approximate the endopelvic fascia overlying the levator muscles in the midline.
See this image and copyright information in PMC

References

    1. Fenner D E. Diagnosis and assessment of sigmoidoceles. Am J Obstet Gynecol. 1996;175:1438–1442. - PubMed
    1. Altman D, Lopez A, Kierkegaard J, et al. Assessment of posterior vaginal wall prolapse: comparison of physical findings to cystodefecoperitoneography. Int Urogynecol J Pelvic Floor Disfunct. 2005;16:96–103. - PubMed
    1. Brubaker L. Rectocele. Curr Opin Obstet Gynecol. 1996;8:376–379. - PubMed
    1. Kahn M A, Stanton S L. Techniques of rectocele repair and their effects of bowel function. Int Urogynecol J. 1998;9:37–47. - PubMed
    1. Delancey J OL, Hurd W W. Size of the urogenital hiatus in the levator ani muscles in normal women and women with pelvic organ prolapse. Obstet Gynecol. 1998;91:364–368. - PubMed