Persistent symptoms of functional outlet obstruction after rectocele repair


Fernando Azpiroz MD, Digestive System Research Unit, Hospital General Vall d'Hebron 08035, Barcelona, Spain.


Background  Rectocele is frequently associated with constipation, but it is not known whether a causal relationship exists.

Objective  To determine the effect of rectocele repair on symptoms of constipation.

Method  Thirty-five women (28–79 years) consecutively operated for rectocele repair (11 transanal approach and 24 transperineal) were included in the prospective study. Using a structured questionnaire, the following criteria for constipation were evaluated: (a) straining, (b) sensation of anal blockage, (c) sensation of incomplete evacuation, (d) manual manoeuvres to facilitate defecation, (e) stool consistency and (f) stool frequency. The evaluation was performed before and 1 year after rectocele repair.

Results  Before the operation all patients had two or more constipation criteria, including sensation of anal blockage. One year after the operation, the incidence of all symptoms significantly improved (from 3.9 ± 0.2 to 1.9 ± 0.3; P < 0.01). However, in 18 patients two or more criteria of constipation persisted, two patients presented one criterion, and only 15 patients became asymptomatic. Neither parity nor the type of surgical approach (endorectal vs transperineal) was related to the response to treatment. In eight patients who had a previous hysterectomy the result was significantly worse.

Conclusion  In a considerable proportion of patients, constipation persists after rectocele repair, suggesting that these symptoms are related to an underlying dysfunction.